Reflections on Mortality: Does Christianity Matter?

Highlights from our recent panel discussion with the Newbigin Fellows

Newbigin Panel (Jeff Brown for The Carver Project)

Last month, Interfaith America and The Carver Project cohosted the first cohort of the Newbigin Fellows for a three-day conference in St. Louis. Our gathering included a public dialogue titled, “Reflections on Mortality: Does Christianity Matter?” I moderated discussion between three of the fellows serving as panelists:

• Lydia Dugdale, an internist at Columbia

• Jen Frey a philosopher and the inaugural dean of the Tulsa Honors College

• Andrea Leep Hunderfund, a neurologist at the Mayo Clinic.

Our discussion covered a wide range of topics, with each panelist bringing a unique perspective formed by her particular expertise. In today’s post, I’d like to share some highlights from the dialogue.

I opened the discussion by recounting an article I wrote in 2013 about online communities. When I began researching that article, I was skeptical that online communities could offer their participants the same meaningful fulfillment as offline communities. Yet I discovered moving examples of online communities that were incredibly meaningful to their participants.

There was, however, one catch: every one of the participants in these online communities eventually died. And as they neared death, their online relationships necessarily transitioned offline. They flew to each other’s homes and neighborhoods, held hands with the dying person, and comforted family members in person. It was a powerful reminder that no matter how much we live our lives online, we die offline in bodily realities.

With this background, I asked Lydia to set the stage by discussing her 2020 book, The Lost Art of Dying: Reviving Forgotten Wisdom. Lydia noted:

I am a primary care doctor, which means that most of my patients are baby boomers and older. And I also do quite a bit of work in the hospital. In both of those roles, I have had the occasion to care for many patients who either themselves died in ways that they did not anticipate or whose family members experienced a kind of highly medicalized dying. When those family members came back to me to process these experiences after having sat in the ICU watching their loved ones die, they often say, “I would never want to go through that again. I never want that to happen to me.”

I have also found myself asking why it is that we have this incredible medical technology, but we are not just using it to save lives. We’re also using it to drag out and extend the dying process. And at some point this incredible technology is actually doing more harm.

Lydia described how dissatisfaction with this kind of thinking eventually led her to the ars moriendi, Latin for “the art of dying.” This was a genre of literature that arose in response to the mid-14th century bubonic plague in Western Europe, which took the lives of one-third to two-thirds of the population. Lydia noted:

In response to the plague, there was a social outcry among survivors: our finitude is inevitable, and therefore we need some sort of tool to help ourselves prepare for death. The central thread of this genre, the ars moriendi, is that if you want to die well, you have to live well. Those two are very interrelated. And therefore talking about mortality is really a conversation asking “How do we live well now in the context of our communities?”

With this background, I asked Andrea if modern medicine knows how to prepare people to die well. Does modern medicine even have the capacity to answer the basic question of what it means to “do no harm”? She responded:

Modern medicine brings so much technology to bear in ways that are incredible but can also obscure dying and hide it away. Like Lydia was saying, it emphasizes technical tools in a biomedical framework. Quite often that’s a space we feel comfortable in as doctors. I can tell patients what’s wrong with them. I can tell them when they have a fatal condition. I can give them a prognosis based on research. But often what they want to talk about is “Why is this happening to me?” and “How am I going to get through it?” When I teach medical students neuroscience, we talk about anatomy, physiology, pharmacology. But we aren’t talking about those bigger life questions.

Jen taught Lydia’s book in an undergraduate class, and I was curious to hear her experience reading it with eighteen to twenty-two year olds. She noted:

There’s a very old-fashioned notion of philosophy as a preparation for death. Now why would that be? It’s because death really clarifies your vision and forces you to focus on what you are living for—what actually matters.

My students responded so well to this book—it was really clear to me that it kind of brought together all of these different issues that we had been talking about the whole class. My class is very heavy on journaling, and I read so many journal entries about how Lydia’s book helped students to think about how they want to die, which is something that they’ve never thought about before. And maybe that forced them to think about how they would live in such a way that this kind of death might actually be possible.

Turning back to Lydia, I asked her to comment on the communal aspect of dying and the extent to which that shapes the process of dying. She replied:

The ars moriendi lasted more than 500 years across many different cultures. There are two things that all versions had in common. The first is an acknowledgement of finitude. You can’t really talk about preparing for death if you don’t acknowledge that you are going to die. And it’s amazing how often we in modern life try to avoid that conversation.

The second thing central to all versions of the ars moriendi is the role of community. Especially in the late Middle Ages, the death bed was meant to be a public place. So as someone was dying, the entire community, the entire parish, would parade past the deathbed to say goodbye, even if you didn’t really know the person. This was part of being in that community.

Dying was always a community affair, and something has been lost in our highly individualized society and even in our nuclear family homes. We’re not in parishes, we’re not in communities, we don’t necessarily know our neighbors. We’ve really lost the sense that dying is a community affair. When you’re breathing your last breath, you shouldn’t be alone.

Later in the conversation, I asked Andrea to elaborate not only on the moment of death but the decay of the body that precedes death. She noted:

One way to think about death is as a separation. An interruption of things that aren’t meant to be split. It’s a schism. The body split from the spirit.

In peripheral neuropathy, there is separation of sensation and ability to feel anything. In a disease like ALS, there is separation from strength and ability to move. In dementia, it’s separation from one’s memory. These separations chafe against us so much because that’s not how it is supposed to be. As a Christian, it’s really those touchstones of creation that let me say “this is not how it was meant to be!”

The resurrection is the promise of a hope that is not just a consolation for what was lost, but a restoration of those things. It’s a material restoration of the body and the spirit—a restoration of those separations that are caused by disease, those that are caused by death, those that interrupt love and relationships—all of those things that make death so cruel and terrible will be restored.

I asked Jen to talk about the role of suffering, and how Christians have hope in the midst of real suffering. She replied:

Suffering is not merely a material phenomenon. We are animals who suffer and feel pain. But we’re also rational animals who need to have a story about our suffering, who need to be able to make sense of it. And we live in a culture that increasingly says that unless suffering is controlled or chosen, it is meaningless.

But our embodiment—our animality—comes with a lot of unchosen suffering that we don’t control. And I think increasingly within medicine, we don’t know what to do with that kind of suffering. We can medicate it, but that’s not enough. And I think this is why so many people now think that end of life suffering should just be taken off the table. The idea is that I address suffering by eliminating the sufferer. That’s the treatment.

This ultimately comes out of a distorted conception of freedom. I think this whole aversion to unchosen limits is increasingly a problem for a culture that understands freedom as just an expression of my will. Anything that is not an expression of my will, including any form of suffering, is either meaningless or bad. And in that context, maybe it is better to eliminate the sufferer rather than address the suffering. This is where Christianity really does matter because we do have a story about our suffering. We have a way of seeing in our suffering the suffering of Christ on the cross for us and for our salvation.

Given some of the themes that emerged in our discussion, I suggested that questions about the purpose of suffering ultimately returned us to questions of the purpose of medicine. Without some other alternative, some people will say that the purpose of medicine is to reduce or eliminate suffering. But that takes us quickly from debates about reducing suffering at the end of life to debates about reducing any kind of suffering that doesn’t feel like a life worth living.

We ended our dialogue with a discussion of hope, and Lydia concluded our time by invoking Aquinas:

Hope for Aquinas is a theological virtue. Between faith and love lies hope for eternal happiness, which for Aquinas is being united with God in heaven. Aquinas says that we can be instruments of hope for others when they are not able to hope. As doctors, we exercise the virtue of hope on behalf of patients who aren’t able to hope, but there will also be times when we’re caring for loved ones where we find it hard to hope. But in those situations, the Church can hope for us. The object of our hope, however, is not cure; it’s not that all of the sadness would go away or there will be no suffering. Rather, the object of our hope is is to be united with God, and we can remind one another of that hope.

I’ve edited parts of the dialogue above for clarity and length. But what I’ve shared only scratches the surface. In addition to these exchanges, our discussion covered a range of issues including medical technology, euthanasia, and other topics. If you’re interested, I invite you to listen to the full audio recording of the panel.