Nowadays, medical technology is often involved in the dying process. We can intervene in Nature’s timetable, delaying or hastening the inevitable. Does technology contribute to a good death? To answer, we need to think about what a good death might be, and about the situations in which technology might be called upon to intervene.
The study of death is called thanatology, and one main strand of this is palliative care, the branch of medicine intended to reduce the pain, fear, and indignity that often attend the very end of life. Most people would, if they could, choose a pain-free and dignified death. And, if there is intense pain from a terminal illness, modern drugs are often very effective. However, there is still uncertainty among some medical professionals about the wisdom of administering increasing doses of pain-relieving drugs (analgesics). Some may fear that these increasing doses may unintentionally kill the patient, leaving those who prescribed and gave the drug open to criminal charges. Yet palliative care research shows that the dying may be able to benefit from much higher doses of analgesics than ordinary patients, along with a reduced risk of lethal side-effects. There is also some research that suggests that starvation and dehydration, which occur towards the very end, as appetite recedes, may be natural analgesics.
This raises questions about the habitual practice of feeding and hydrating patients via tubes. Should these be withdrawn towards the end, as their presence can be irritating and constraining? Another issue is what happens if a terminally ill patient suffers a heart attack. Should attempts be made to resuscitate, even when studies show a fairly low rate of success? These points relate not just to pain, but to the dignity of the individual, as feeding tubes are invasive, and resuscitation is a highly intrusive procedure. If dying is seen as a process of deliberate withdrawal from physical incarnation, planned by the soul, then it may be that resuscitation is an unwelcome disturbance, and even feeding and hydrating beyond a certain point is an unnecessary delay.
Jon D Fuller MD, a Jesuit doctor, makes the following plea for simplicity:
“I've often thought about the capacity that humans have had for tens of thousands of years to attend to their dying loved ones, and one criterion that makes sense to me for what is appropriate care at the end of life is this: What can you do in a cave? In a cave you can hold people, you can rock them, you can sing to them, you can bathe them, you can provide care to prevent drying of the mouth and lips, and you can give pain medications that do not have to be swallowed.”1
Another factor to consider, is to what extent the use of technology, and the overall pattern of care, may interfere with the patient’s psychological state, as they may well be engaged in deep reflection on their life. This life review is an important opportunity for a person to revisit their life experiences, to identify key moments, and to synthesise a more complete understanding of the meaning of their life and times. Because of routine, medical staff might unintentionally interrupt this process. This is an area which thanatology researchers might well explore further. Alice Bailey remarks, “First, let there be silence in the chamber. This is, of course, frequently the case. It must be remembered that the dying person may usually be unconscious. This unconsciousness is apparent but not real. In nine hundred cases out of a thousand the brain awareness is there, with a full consciousness of happenings, but there is a complete paralysis of the will to express and complete inability to generate the energy which will indicate aliveness. When silence and understanding rule the sick room, the departing soul can hold possession of its instrument with clarity until the last minute, and can make due preparation.” (Esoteric Healing, p.456) 2
This proposal that silence is important would appear to be in tension with the further proposal that: “Certain types of music will be used when more in connection with sound is understood, but there is no music as yet which will facilitate the work of the soul in abstracting itself from the body, though certain notes on the organ will be found effective.” (Ibid. p.457) However, the understanding of when silence is needed, and when it is appropriate to use sound is something that will presumably emerge from continuing sensitive research. A sign that the work of using sound has already begun is the recent emergence of the branch of thanatology called music-thanatology, which focuses on the use of "music vigils" to help the individual and their family. A vigil consists of one or a team of music-thanatologists who visit the dying person. They play the harp and sing a certain repertoire of music that may be very helpful to the patient and their family. It is reported that, often, after a vigil, the dying person is more relaxed, less agitated, and in less pain. 3
From the social angle, it seems we currently live in a death-denying civilization, with cosmetic surgery promising endless youth, and the unproven technology of freezing bodies (cryonics) proposing that people can be kept suspended until a time when terminal illnesses are cured. There is also the suggestion that life could be sustained indefinitely, by replacing more and more organs of the body with mechanical devices. And some have even claimed that personhood is defined solely by the brain, and so if a complete ‘copy’ of a person’s brain activity could be made, then it could be ‘downloaded’ into a computer, thus somehow conferring immortality. But do these attempts to deny death not also deny the essential core of life, which is change? Another aspect of this death-denial may be emerging in the increasingly expensive medical treatments required in old age. Can spending large sums to extend life by a few months be justified, when there are so many other needs in hard-pressed health-care systems? Theology Professor Lisa Sowle Cahill makes a remark which, although it refers to the case of the American woman, Terri Schiavo, is equally relevant to the wider question:
“Both sides fixate on whether to provide high-tech medical care, which normalizes it as a way to handle illness and death. We're forgetting the 45 million people in [the USA] with no health insurance; we're forgetting people in other parts of the world who don't have even basic medical care; we're forgetting about our national obligation, which we've not met, to the global fund to fight AIDS, malaria, and tuberculosis. What is the bigger picture for health resources and humane care? The dangers as we focus on end-of-life issues are not necessarily the ones that we immediately perceive.”4
In the final analysis, just as each one of us must learn to face up to the fact of death, so, too, must society. Perhaps then we will see a shift away from the current emphasis on technology, towards giving more time and attention to the human side of facilitating a good death.
1. From Boston College Magazine, Spring 2005, at http://bcm.bc.edu/issues/spring_2005/ft_endoflife.html
2. Esoteric Healing, by Alice Bailey, is available from the Lucis Trust web site at: http://www.lucistrust.org/purchase ; also available is the compilation Death: the Great Adventure.
3. For more information, contact: The Chalice of Repose Project, P.O. Box 169, Mt. Angel,OR97362-0169,USA; Tel: +1-503-845-6089; Fax: +1-775-218-2591; Email: firstname.lastname@example.org; Web: http://www.chaliceofrepose.org/
4. See 1