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
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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. |
