Mark Miller, C.Ss.R. Ph.D.
During the first half of the twentieth century less than 30% of Canadians died in hospitals. By the 1970’s this number rose to over 70%. Except in cases of sudden death, hospitals became the locus of the dying.
There is, however, a problem with dying in a hospital. Dying is somehow sanitized by the white walls and the clean- gowned servants of modern medicine. Ordinary human relationships are often subdued within the hospital atmosphere. Certainly, the intimacy of the family home is replaced by the semi-public, scheduled patterns of the hospital. The ordinary surroundings of home are far away, and that includes the well-known smells, colors, sounds and people of home. Grief itself is turned into a private, often hidden experience, squeezed by the confines of the institution. A loved one dies in the midst of the subdued, somewhat impersonal cleanliness of the institution rather than in the midst of the familiarity of one’s own home.
Since hospitals are generally geared towards helping people regain their health, the dying have always been a bit of an embarrassment for doctors and hospitals. There has been a tendency either to throw every possible medical intervention at the dying person in order to stave off death or to tiptoe around the dying because ‘there is nothing more we can do.’
Palliative care, which is proper or appropriate health care for the dying, acknowledges that the dying are dying. Accordingly, hi-tech interventions that only prolong the dying or that make one’s dying more painful and burdensome are set aside in the interests of ensuring that the patient is comfortable, pain-free, and given time to face his or her death without needless medical interruptions. The more human aspects of dying, rather than the chemical or biological functioning of the body, become the focus of the process. Indeed, one of the efforts made by palliative caregivers today is to assist with proper care all those persons who wish to die at home.
Of course, whatever seriously interferes with the human ability to live must be dealt with in palliative care. Pain control is essential. (For some this makes dying at home impossible.) Nor does palliative care mean that appropriate surgery or medical treatment is thrown out the window. Rather, such interventions are acceptable as they fit the needs of the patient. Proper treatment may well relieve some trying symptoms even if no amount of treatment will reverse the dying.
To my way of thinking the insight of palliative care is simply that the living of those who are dying is taken seriously by the caregivers. Instead of being passive recipients (as in the word ‘patients’) of whatever medical interventions ‘might’ work—but will certainly complicate the patient’s life, as do surgery or chemotherapy—those who are irreversibly dying are able to concentrate on this time of living. It is instructive to see what is important to the dying. Some people want to ensure that they have told all their family members how much they are loved and how gratefully they have been appreciated over many years. Others know that dying is a time for reconciliation, for healing old wounds (often things that don’t seem so serious anymore, under the circumstances), for renewing family ties. Still other people have projects that they want to complete, like the business woman dying of cancer who wanted to be as free of pain as possible over a one-month period in order to say goodbye to most of her regular customers.
Nor is the time of dying only a time for ‘doing things.’ In our goal-oriented society, we often forget that things can happen to us and for us. While dying, for example, I firmly believe that God is extraordinarily active. New insights, new awareness even of the place of suffering in human life, new wonder at the gift of life, suddenly experiencing the gift of peace and acceptance, the paradox of knowing more deeply how much you love and are loved—these and many other treasures await those who enter into the dying process as part of living. These are gifts of the spirit through a deeper awareness of God’s activity in our lives, in our loves, and in our need. If we fear death or dying, we need to remember that the opposite of faith according to Jesus is fear. Death becomes a final calling into the Lord’s trust.
Many people today argue that ‘controlling my death’ is an important ‘right.’ What they can only mean, of course, is controlling the moment of dying. But who knows when it is the right time to die? Who knows what the Lord will do with the days remaining in our lives despite our readiness to give up?
The Christian response of the dying person must be a complete trust in and abandonment to our loving God— remembering the Gethsemane of Jesus as the pain-filled limitlessness of this trust. And the rest of us, those who are called to accompany the dying person in any way, must remember that our calling is to care for the dying person in all the ways that respect his or her dignity as long as God gives the gift of life. Together, perhaps, we can discover God’s abundant love where human perceptions are not enough.