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From the January/February, 2008
issue of Touchstone

 

Spiritual Morphine by Kristina Robb Dover

Spiritual Morphine

The Delusory Hope of Dying on Your Own Terms

by Kristina Robb Dover

The doctors had said she had little more than six months to live. Since then, the cancer had aggressively metastasized, but not enough to destroy her insatiable will to live. Esther, 72, talked confidently about God’s power to heal both the pain and the cancer.

When I asked her where she drew her inspiration from, she cited the teachings of Joel Osteen and his mother, Dodie Osteen, who, in a little book titled Healed from Cancer, attributed her own miraculous recovery to a strict, daily regimen of reciting particular “healing” verses from Scripture. Invoking God’s Word “against the devil” in the guise of aches and pains took its place next to a special diet of pureed fruits and vegetables and occasional rounds of chemotherapy.

I decided that I would check out the Osteens’ teachings for myself. What I found was an innocuous, pain-free form of faith with a quid pro quo for its adherents. “Claim God’s Word in your thoughts and speech, and you will be healed, because God’s will for you is to be healthy and happy” is a good summary.

With the exception of a few scarce references to Jesus Christ, Joel Osteen’s Your Best Life Now reads more like a secular self-help manual than a Christian work. It offers “seven simple, yet profound, steps to improve your life”: “enlarge your vision; develop a healthy self-image; discover the power of your thoughts and words; let go of the past; find strength through adversity; live to give; and choose to be happy.” Nothing about pain, or dying, or death, about lives that can’t be “improved” but have to be endured.

Pain-Killing Care

Osteen’s teachings reflect one incarnation of a gospel touted for its painkilling properties. But Esther’s enthusiastic conversion to the Osteens’ teaching points to a larger phenomenon of religion as pain relief that both intrigues and disturbs me: its role in care for the dying.

As a hospice chaplain, in weekly meetings convened to discuss patients’ care, I took my seat next to doctors, nurses, and social workers, all of whom had made it their single, greatest aim to relieve the pain of terminally ill clients. This place at the table for religious faith deserves celebration: first, because it signifies a growing appreciation for the spiritual dimensions of health and, in turn, significant advances in understanding how to care for whole persons; and second, because it may be an example of how science and religion are learning to converse with one another in a shared language.

Yet the highest, governing value presumed in these meetings was the necessity of freeing the patient from pain, physical, emotional, or spiritual. It is this presumption that gives cause for concern. In my experience as a hospice chaplain—and I know that others may have a very different and more extensive experience—this value has become an implicit, guiding principle that directs chaplains in their ministry of “pain relief.”

Some will dispute this interpretation. They argue that hospice is less about pain relief and more about patient autonomy, but I am not so sure these are two different things. If the customer is “always right” (as he usually is in the privatized hospice setting with which I am most familiar), the overriding goal of palliative care is to keep the customer as comfortable as possible. Eliminating sources of pain and discomfort is the most obvious way to do so.

If I am right about this principle, I think it relies on two unspoken, common assumptions.

Redemptive Death

The first is that the terminally ill patient is always right. Because he is on the threshold of death, he is presumed to enjoy greater access to virtue and judgment than is attainable by those who dwell in the land of the living. He attains a kind of sanctified status.

This attitude of reverence towards the dying is one that the journalist Ron Rosenbaum describes as “an increasingly cultlike exaltation, sentimentalization and even worship.” He attributes its prominence at least in part to the work of Elisabeth Kübler-Ross. Her books have become the standard texts for the dying and those who care for them—as I discovered, having received many “recommended reading” lists during chaplain residencies at two separate sites.

It may be true that while pain relief is a large part of hospice care, it is not an end in itself, but a means of helping patients resolve various emotional and spiritual end-of-life conflicts. Even so, the use of palliative medicine as a way to encourage the pursuit of emotional and spiritual wholeness is still about helping the patient achieve his best death on his own terms.

The measure by which the success of this endeavor is evaluated is the degree to which the patient expresses pain, physical, emotional, or spiritual. The standard for success, in other words, is whether the patient “feels good” physically, emotionally, and spiritually.

The second assumption is that death, embodying a “natural” transition to a carefree afterlife, is a good in itself. After reportedly studying some 20,000 cases of “near-death experiences,” Kübler-Ross concludes that life after death is universally a “glorious experience” and a “pleasant reunion” of sorts: “There will be a total absence of panic, fear, or anxiety”; “you will be very beautiful, much more beautiful than you see yourself now”; and you “will always experience a physical wholeness.”

Everyone experiences this happy transition to a blissful new way of being. “Even the angriest and most difficult patients, very shortly before death, begin to deeply relax, have a sense of serenity around them, and begin to be pain free in spite of, perhaps, a cancer-ridden body full of metastases.”

Given this reassuring paradigm, it is no exaggeration to suggest that death attains an almost divine status for its ability to redeem human beings from the sufferings of life.

To commemorate the life of a patient known by his children as a delinquent father and by the medical staff as an ornery old man, the chaplain presiding at his memorial service played, in celebratory fashion, the Frank Sinatra hit, “I Did It My Way.” Tears were wept in reverence for a man who lived and died “his” way, even though it may have been a wrong and destructive way.

The suggestion? That through death, an otherwise less-than-exemplary and miserable person had become a kind of sage whose way of life called for emulation from his students, and that dying would be as triumphant and carefree for this man as living his way had been.

Disturbing Implications

For the chaplain who is a “mere Christian,” this underlying principle of pain relief contains some disturbing theological implications.

The first is that God is a God of grace only, not of judgment, with the implication that an orthodox Christian understanding of human sin and our need for divine pardon is outmoded and inadmissible. Guilt, regret, or a conviction of divine wrath only fosters unnecessary discomfort, and must therefore be eliminated.

Where this belief plays out practically at the bedside of a dying patient is in the prescribed omission of prayers of confession and petitions for God’s forgiveness: Unless the patient makes a specific request, the chaplain is forbidden to suggest it, even if the patient is a Christian. Unless a patient clearly professes a particular faith—the chaplain’s job is to summon a Catholic priest to perform last rites for Catholics, for example—such religious practices are in fact discouraged.

In this context, the “meaning” that a patient derived from hosting cocktail parties or playing golf is as significant for patient and chaplain as are expressions of his relationship with God. (After all, as the commonly occurring assumptions go, the patient is always right, and death for all is nothing but a sublime passage to a better place.) “Spirituality” in turn is reduced to little more than a list of personal preferences and hobbies.

When I met him in the months before he died, Mr. Z. was a self-described “backslidden” Christian. He had made a lot of mistakes in his life, and was notorious in his last days as the angry old man who had it in for the hospital staff. Even his daughter spoke with ambivalence and regret about the way her father had lived his life.

In the moments before he died, moments preceded by desperate cries for a quick end to his life, I was at his bedside, and in a final prayer that included thanksgiving for his life, I asked God to “forgive the things” he had “done and left undone.” Afterwards, I noted (among the “spiritual” interventions that chaplains are required to chart for each patient) that I had “prayed for patient’s forgiveness.”

After reading my notes, a fellow chaplain and supervisor zealously interrogated me about why I had felt it necessary to pray for forgiveness for Mr. Z. Unless Mr. Z. had vocalized in his dying moments that he wanted forgiveness—which would have been nearly impossible in those last minutes of fleeting consciousness—I was not to pray such a prayer. “You need to set your theology aside in interactions with patients,” I was told.

Such a reprimand leads us to the second disturbing implication of this principle of palliative care: The chaplain must leave his “theology” at the door before entering a patient’s room. The chaplain’s primary purpose is to embrace the patient’s definitions of truth and salvation, whatever they might be, with the goal of helping him feel affirmed and, in turn, pain-free and comfortable.

One colleague confidently declared that “no Evangelical Christian would ever be hired for a chaplaincy position, because an Evangelical is not capable of leaving his views out of patient interactions.” The presumption here that a chaplain can indeed set aside the system of beliefs that has shaped his life fails to recognize the inextricable link between theology and practice—namely, that the practice of “leaving one’s beliefs at the door” is in fact a manifestation of a particular theology.

Jesus’ Pain

In a great stroke of irony, then, the principle of freeing the patient from pain offers a version of Christianity that, while vastly different in content, shares the same fundamental motivation to relieve pain and promote happiness that drives Osteenism. While Osteen would have us eliminate pain with the mantra, “Your best life now,” proponents of the hospice culture seek to conquer it with the advertisement, “Your best death now.”

But is “feel-good faith” really in keeping with the church’s charter story? There I read of a life of pain and discomfort for the man named Jesus and his band of followers. From his birth in a filthy stable, to the scorn of his home town and the rejection of his own people, to his grisly death on a cross, Jesus chose a life full of pain and discomfort.

His disciples did the same, rejecting easier ways to embrace the Way. Their path was not one of pain purely for pain’s sake, or martyrdom for the sake of martyrdom. Pain was not their highest and governing value, but neither was pain relief. They had come face to face with something more worthy of joyful worship: rescue from the meaninglessness of existence and a claim on their life in the person of Jesus Christ. For that, they would gladly suffer.

So I ask if we haven’t gotten Christianity just a little wrong when we turn it into just another means of escape from what we all must face some day. Pain, after all, is itself not only inevitable but a necessity for us: It is a reality check, a reminder of mortality, something anesthetic belief categorically denies.

Simone Weil goes so far as to say that in the same way that the natural phenomenon of a sunset reminds us of the order and beauty of creation, so too does affliction—it is written into the delicate structure of the universe to which human beings belong and ultimately must give heed. In her essay, “The Love of God and Affliction,” she writes:

Each time that we have some pain to go through, we can say to ourselves quite truly that it is the universe, the order and beauty of the world, and the obedience of creation to God that are entering our body. After that, how can we fail to bless with tenderest gratitude the Love that sends us this gift?

By agreeing with Weil that even pain can minister God’s grace to us, I do not intend to glorify suffering purely for suffering’s sake. There is nothing redemptive in suffering alone. Nor do I wish to suggest that death is a good. The Bible is clear from start to finish that just as death did not belong to God’s original plan for creation, death will not have a place in the heavenly resurrected life that God promises to those who love him.

My unease is with a Christianity that in a highly therapeutic, health-obsessed Western culture genuflects before the idols of comfort and happiness. A religion that assigns greater value to pain relief in the here and now than to the lordship of Jesus Christ has only succeeded in erecting another golden calf, with the damaging result that health and comfort and a pain-free death are falsely proclaimed as the answer to the riddle of human existence.

Such misplaced worship is a far cry from “true religion,” understood as that “which binds us to God as the one and only God,” in the words of John Calvin (a man, incidentally, racked with illness his whole life). It falls prey to the kind of utilitarianism that Friedrich Schleiermacher once bewailed: religion that exists not for its own sake, but as a means to an end—in this case, the relief of pain.

The Only Comfort

This brings me back to the quandary of my role as a chaplain to Esther, Mr. Z., and the many like them, who, through either the empty promises of Osteenism or the misleading claims of hospice culture, cling to the empty promises of a spiritual anesthesia with the hope that I, as their chaplain, would alleviate their suffering once and for all.

Should I, like the good and able medical professionals with whom I work, attend to the bedsides of the sick with the sole purpose of easing their pain? Is my role to administer a spiritual morphine drip? Or am I called to deliver another proclamation, one that serves a greater, more life-giving end?

Perhaps the beginning of an answer to this question lies in the prayer that Jesus uttered in Gethsemane on the eve before his crucifixion. “Father, if you are willing,” he pleads, “remove this cup from me; yet not my will but yours be done.” In those words is the acknowledgment that no one is the ultimate master of his destiny but that we live, rather, in submission to the will of the Creator.

And perhaps this reality is consolation enough, for in the words of the sixteenth-century landmark document of the Protestant Reformation, The Heidelberg Catechism, there is but one clear answer to the question, “What is your only comfort, in life and in death?” and it is “that I belong—body and soul, in life and in death—not to myself but to my faithful Savior, Jesus Christ.”

Ron Rosenbaum’s comments appeared in “Turn On, Tune In, Drop Dead” in the July 1982 issue of Harper’s, reprinted in his The Secret Parts of Fortune. Elisabeth Kübler-Ross’s comments are taken from her Death Is of Vital Importance. Simone Weil’s “The Love of God and Affliction” can be found in her book Waiting for God.

 

 

Bedside Advisors

Many physicians, in my experience, have largely forgotten the philosophical foundations of medicine. They once professed accountability to something higher than the market, but most have long since stopped acknowledging the possibility of knowable, universal accounts of human health.

How does medical care differ from human engineering? What makes for a good death? For that matter, is life itself good? Even if it comes with pain or without consciousness? The doctors who dare to profess answers to these questions are kept closeted, lest their host institutions become “sectarian” and lose insurance reimbursements or government support.

In the vacuum of substantive moral reason, patient autonomy expands to fill the space. What was once merely one element of moral-medical reflection has become an idol, the sole principle to which medicine must always pay lip service. Physicians and those lower in the medical caste system (nurses, social workers, aides) may subtly push their own agenda, but always with at least the pretense of honoring the patient’s wishes.

In disputed cases, they may act more on behalf of the family than the patient, but with the excuse that the family may have divined the patient’s true opinion. Palliative care physicians (yes, they do exist, and board certification is now available) are no different: Patient autonomy is the only overt rule of medical care.

As it happens, most patients want chaplains. The chaplain is a “man of God,” a reminder of the hope of something bigger or better, a visible sign of faith even when the patient himself feels faithless. Families, too, like to have chaplains—or at least, they like to imagine that their loved one finds them comforting, and that imagination is itself comforting.

Either way, hospices need chaplains, both in response to the patients’ wishes and in the maintenance of good relations with their families. Hospice managers and physicians may not respect chaplains, however. They may and often do think of them as merely bringing false comfort to the otherwise hopeless. They may even despise them. No matter: Chaplains are good business, because patients and families want them.

The major chaplains’ certification agencies (Protestant APC, Catholic NACC, Jewish NAJC) do not expect chaplains to leave their theologies at the door, notwithstanding the market pressure. On the contrary, the certification process requires chaplains to be able to render an account of their theological anthropology and its application to pastoral care in institutional settings.

Of course, the certifiers are afflicted by the same politics that plague church governing bodies, seminaries, and so forth. Liberals arguably prefer these jobs. I don’t doubt that serious Evangelicals (like serious Catholics or religious Jews) are often impeded in the certification process. On the other hand, the trainees probably also consist largely of liberals, so some serious Christians will occasionally be encouraged just for the sake of diversity.

But some health care institutions, including hospices, will abandon the professional standards and regard chaplaincy as a mush-minded form of social work. They reap the result of the “soft bigotry of low expectations”: Instead of hiring chaplains, they go for a lower grade of “spiritual advisor.”

These institutions may imagine that while chaplains are woefully committed to a constellation of theological perspectives, spiritual advisors are free to adapt their personal stance to whatever each patient asserts as his philosophical or religious perspective. This is simply stupid and naive, but it saves the hospital a lot of time and money, so it’s increasingly common among those institutions that want to profit from the business of spirituality without establishing more credible chaplaincies.

Christians who take jobs as chaplains may have some protection afforded by the professional standards of the certification agencies, but those hired as spiritual advisors should read their job descriptions very carefully. They may find that they are selling their souls for a salaried position.

— David Poecking


Kristina Robb Dover currently directs communications for Presbyterian Global Fellowship (www.presbyterianglobalfellowship.org). A graduate of Princeton Theological Seminary, she has written for Theology Today, The Christian Century, and other magazines, and is a candidate for ordination in the Presbyterian Church U.S.A. She currently resides in Atlanta, Georgia, with her husband Paul and their ten-month-old son, Cam.

Letters Welcome: One of the reasons Touchstone exists is to encourage conversation among Christians, so we welcome letters responding to articles or raising matters of interest to our readers. However, because the space is limited, please keep your letters under 400 words. All letters may be edited for space and clarity when necessary. letters@touchstonemag.com

 

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