Archive for October, 2013

005 ‘dying well’ versus ‘the good death’

I’ve just started my M.Litt dissertation.  My supervisor suggested the practice of writing something every day, something akin to a journal entry rather than a formal academic piece.

I have neither the time nor energy to write every day, but I will when I get the chance and I suppose why not put it out here for the 7 people who read this to see it, critique and hopefully give me some feedback to make it better. 

The basic idea for the thesis goes something like this:

How does modern medicine’s domination of how we die form problems for the Christian tradition of Ars Moriendi

Here’s what I wrote today:

 

While on the surface it’s perhaps difficult to see the difference between the two terms

  • Dying well

  • The good death

Yet, if I’m correct (and it’s yet to be seen) then there’s an important difference to be drawn out.

Like most phrases like this, it all depends by what you mean by them. Both are so short as to carry very little specific meaning. There is some specific content to them but it’s also how, and by whom the two phrases are used that helps to bring out the differences.

Dying well has its origins in the Christian ars moriendi literature already discussed. The ars moriendi means the “art of dying well”. It was a specific body of Christian literature, coming in the time following the great schism and the black death. It was popular literature for those unfortunately accustomed to wide spread, horrific death.

Christians can die well, so the ars moriendi go. There may be temptations to avoid, and virtues to pursue but we can at least die well. There are many modern day Christians and non-Christians who continue to use the phrase ‘dying well’ as a goal for those confronted with their own mortality. Given the rampant medicalisation of our deaths, the contemporary idea of dying well has been a welcome asset. Palliative care is perhaps the best example that the medical field has put forward, with a focus on symptom control and dying at home. [Not that palliative care is without its problems as I’ve previously mentioned.]

The good death is (i hope to argue) a somewhat different term. Sitting on my shelf is a book of the same name, subtitled ‘the new american search to reshape the end of life’. The subtitle tells a tale in itself. When I talk about the good death, I’m taking about the modern notion that the good death is the death that is freely chosen. The modern emphasis on the self and on autonomy is the key here. What people often fear most in the contemporary world is the loss of choice, autonomy and independence that ill health brings. The only way that such a situation might end well is in the death freely chosen.

It is no coincidence that the language of the good death is perhaps most prevalent in those talking about ‘assisting dying’. One of the ways to make it slightly more palatable is to rephrase what we think about death. If death is ‘natural’ (hard to argue against) and so is childbirth then surely death is just one part of the journey. Indeed, death is the most natural thing in the world. We can avoid the nastiness surrounding our death by taking back ownership of it.

At present I have no real idea if that’s really what the new good death literature actually says. I may be painting a horrible caricature of it. But what I’m going to attempt to say is that as Christians, we can die well, we have all kinds of spiritual and moral resources available to us that perhaps not everyone does. However, I don’t think we can sign up to a good death. There was never anything good about death and yer man Thomas was onto something when he asked us to ‘rage against the dying of the light.’ Paul was onto something similar when he said his bit.

004 On Death and Dying by Elisabeth Kubler-Ross

I’ve just started my M.Litt dissertation.  My supervisor suggested the practice of writing something every day, something akin to a journal entry rather than a formal academic piece.

I have neither the time nor energy to write every day, but I will when I get the chance and I suppose why not put it out here for the 7 people who read this to see it, critique and hopefully give me some feedback to make it better. 

The basic idea for the thesis goes something like this:

How does modern medicine’s domination of how we die form problems for the Christian tradition of Ars Moriendi

Here’s what I wrote today:

Elisabeth Kubler-Ross [via the Simpsons]

On Death and Dying is so famous that even the Simpsons have covered it. This book, written in the hay days of medical advances of the the late 60s and early 70s, tells of insights gained by talking with the dying.

Elisabeth Kubler-Ross was a psychiatrist who set up a seminar (prompted by several theology students with an interest in the topic) in the university to be attended by students and staff from multiple disciplines. The idea was to get insight into how to talk to those who were terminally ill. Typically this took the form of a recorded interview between Kubler-Ross, the patient and often a chaplain. This was usually viewed by a group of students through a one way glass to make the patient feel slightly less intimidated.

The book works its way through the chapters outlining what Kubler-Ross saw as the stages a patient went through when faced with their own death. Most stages are presented in the form of the transcribed interview and from this some conclusions are drawn about how we react towards death. It is summarized in the (slightly dodgy) graphic below.

The book is remarkable as one of the first major contributions to understanding of how we die in the modern age. As already discussed, modern medicine has radically changed how we die. We die later in life, and in many ways we only allow ourselves to die when modern medicine says it is OK to do so.

Death is frequently a medicalised event that takes place not in the home but in the hospital. There are always opportunities for family to visit but this is usually strictly controlled by the hospital until the point is reached that the doctor decides that there is a change from curative to palliative care.

This is the medical context of death but this is surrounded by a much greater, and more pervasive cultural change to how we understand our lives, ourselves and our purpose.

On Death and Dying is effectively a qualitative, observational study. From an empiricists point of view, this type of study is not designed to describe causality, it merely describes people’s reactions to dying, not why they are reacting in such a way.

http://xkcd.com/552/

One of the underlying and unspoken assumptions in the book (and underlying the project of modernity) is that the story of your life is whatever you make it to be. You, as the autonomous self, the agent, are the free and unencumbered individual. This agent can be abstracted from the cultural and contextual ‘you’ in greater society. As Hauerwas puts it, “the project of modernity was to produce people who believe they should have no story except the story they choose when they have no story.”

It appears (though I cannot find it clearly stated as a purpose in the book) that the ‘steps’ or ‘stages’ of dying have guilt-free acceptance as their end point or telos. For example, “if we tolerate their anger, whether it is directed at us, at the deceased, or at God, we are helping them take a great step towards acceptance without guilt .” [Kübler-Ross, Elisabeth. On Death and Dying, Routledge, 1973, p159.] As stated above, this book is a qualitative observational study yet the conclusions drawn, at least implicitly, are that these stages should be normative for modern man. This is the telos of our death – a guilt free acceptance.

A guilt free acceptance of the end of our lives is no bad thing, yet, for the Christian, it is not the whole story, and indeed it deals insufficiently with what has gone before. If the telos in On Death and Dying is only directed at the death then it is insufficiently telological to provide to help us become people able to die well.  Modern death narratives, even at their very best as exemplified here, fail us by not paying sufficient attention to the life that comes prior. A guilt-free acceptance of death is no doubt a grand thing, but dying well may be much more than this.


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