I’m going to quote a number of medical professionals in this post. Our determination to live longer and healthier has meant that we have also forgotten how to die well.

“There seems to be an epidemic of medical overtreatment spreading across the world. Sometimes it seems to be driven by medical arrogance and machismo. Sometimes there are perverse incentives for doctors or for hospitals that reward expensive but futile and burdensome treatments. Sometimes medical overtreatment is driven by doctors’ inexperience or by fear of litigation. But even very experienced doctors may persist with overtreatment because of a sense that death represents a failure of medical skill and professionalism. If we buy into the modern medical narrative of an unceasing struggle against disease and death, it seems we are condemning ourselves to die as passive hostages in a battle waged by impersonal professionals. Sometimes we need the courage to say ‘no’ to the possibilities of burdensome medical treatment.”
— Dying Well: Dying Faithfully by John Wyatt, MD

Dr. Wyatt has been a practicing pediatrician in the UK for more than 40 years. He uses the phrase “medicalization of death” to describe the phenomenon of medical overtreatment.

Several years ago I read an op-ed by a practicing emergency room physician who offered the same perspective as Dr. Wyatt. He opined that medical advances have turned death from an event into a process often stretching out years and involving increasing pain, suffering, dementia, incontinence and immobility. His rational for writing? To educate people that they have a choice and do not have to go to the ER; however once in that ER they no longer have a choice as he is obligated to do everything he can to keep them alive.

In refusing medical treatment, we are not talking about euthanasia.

“It is important, however, to maintain a clear distinction between killing a person and letting someone die. Killing in the wrongful sense of murder, as prohibited in Exodus 20:13, means actively doing something to a patient that hastens or causes his or her death. But “letting someone die” means allowing someone to die without interfering with the process that is already taking place. In cases where it is clearly known to be the patient’s wish to be allowed to die, and when there is no reasonable human hope of recovery, and where death seems imminent–then it does not seem wrong to allow such a person to die, rather than either to initiate an artificial life support system or to prolong the natural dying process by artificial means. For such situations, nothing in Scripture would prohibit a dying person from praying for God to take his life.” – ESV Study Bible in article entitled “End Of Life”

The perspective from another doctor: “The more medicalized death gets, the longer people are debilitated before the end, the more cloistered those who die become, the more terrifying death gets . . . the rise in chronic diseases has indelibly changed death for human beings. Death, in most cases, is no longer a sudden conflagration, but a long, drawn-out slow burn.” — Modern Death: How Medicine Changed the End of Life by Haider Warraich, MD

“Some years ago, I helped tend to a friend of mine who was dying of cancer. Near the end of his life, he had reached a place of equanimity around dying. But instead of honoring his wishes for a peaceful death, his doctors ordered aggressive chemotherapy treatment, which did nothing to halt his cancer. The treatments caused him immense suffering, rendering him unable to sleep, eat, or converse with family and friends as he was dying. Unfortunately, deaths like my friend’s are not that rare. Though more than 70 percent of Americans surveyed say they want to die in their own home without unnecessary procedures to extend their lives, 50 percent of all deaths occurs in facilities away from home. Of those, 40 percent occur in ICU’s, where physicians are charged with doing everything they can to keep a person alive, regardless of the outcome.” – Charles Garfield, Seven Keys To A Good Death

“The medicalization of life under the influence of health-care systems, focused on curing diseases, has made dying well challenging.” – The Lancet, Healthy Longevity, Vol 2, Issue 9, Sep 2021

“Now, with new technologies, what happens is we are able to help people through those potentially fatal episodes. But what happens is that now, people live longer, but with more chronic diseases. And especially closer to the end of life, many patients have multiple chronic diseases that we can at best manage, but that we can’t cure. They’re in and out of the hospitals. In some ways, dying has become a phase of our life, instead of being just an instantaneous sort of flash event.” – Haider Warraich, a cardiologist at Duke University Medical Center

With more people dying in hospitals, often in the intensive care unit, death has become hidden from view. In the opening pages of her book, Dr. Lydia Dugdale – an internal medicine doctor and assistant professor of medicine at the Yale School of Medicine, affirms the Ars Moriendi tradition of helping one’s community members to die well which continued for several hundred years. However, subsequent events, including the American Civil War, scientific advance, and the increasing proliferation of hospitals with their intensive care units, ushered in a new way of approaching death. Over the years more and more people have died in hospitals removed from family and friends and from society’s view.

“All too often, I have seen invasive medical treatments transform the last weeks of life from a time of peaceful preparation for death into a miserable, wretched experience.” — Dying Well: Dying Faithfully by John Wyatt, MD

“In a paper published in the Lancet in 1971, the authors indelicately wrote, “It seems that many of those who survive into old age enter a phase of ‘pre-death’ in which they outlive the vigor of their bodies and the wisdom of their brains . . . These days, not only are people dying more often in hospitals, they are seeing a lot more of the hospital in the time before they die. In 1969, about 1 percent of people were admitted to the hospital in the last year of their life; this number went up to 50 percent by 1987. Nowadays, barely one patient in five is able to die in their own home, down from all five not all that long ago . . . 40 percent of Americans will die alone in nursing homes.” — Modern Death: How Medicine Changed the End of Life by Haider Warraich, MD

There is an interesting study of the impact of religious belief on medical treatment. Study Conclusions: Positive religious coping in patients with advanced cancer is associated with receipt of intensive life-prolonging medical care near death. Those with religious beliefs are 4 times more likely to die alone in an ICU. – https://pubmed.ncbi.nlm.nih.gov/19293414/

“Surprisingly, the researchers found that ‘religious coping behaviour’ was associated with a markedly increased preference for receiving all possible medical treatment, even when it had no chance of prolonging life. Religious patients were more likely to die in an intensive care unit, receiving full life support to the very end, than those who stated that they did not have religious beliefs. Why was this? Some religious people said they believed that only God could decide when a patient should die, hence to refuse any possible treatment was ‘tantamount to euthanasia’. Others said they believed they had to carry on with maximal treatment to the very end, in case God was going to do a miracle. Some said that accepting palliative care meant ‘giving up on God’. But can we really believe that dying in an intensive care unit, surrounded by the impersonal technology of infusion devices, monitors and life-support machinery, is the best way for a Christian believer to end his or her life on earth? . . . It seems sadly ironic that the effect of Christian convictions about miraculous healing can lead unintentionally to death in an intensive care unit, sedated or anaesthetized, surrounded by machinery and cared for by anonymous professionals–above all, tragically isolated from loved ones and all the possible sources of human and spiritual consolation.” – Dying Well: Dying Faithfully by John Wyatt, MD

“How people die has changed dramatically over the past 60 years, from a family event with occasional medical support, to a medical event with limited family support.”
Libby Sallnow, co-chair, Lancet Commission on the Value of Death

Dr. Ezekiel Emmanual, a practicing oncologist snd bioethicist, is a senior fellow at the Center for American Progress. He is the current Vice Provost for Global Initiatives at the University of Pennsylvania and chair of the Department of Medical Ethics and Health Policy. Previously, Emanuel served as the Diane and Robert Levy University Professor at Penn. He holds a joint appointment at the University of Pennsylvania School of Medicine and the Wharton School and was formerly an associate professor at the Harvard Medical School until 1998 when he joined the National Institutes of Health. He has publicly stated that he will reduce his medical care at 75. While he will accept minor/normal care, he will not accept major medical intervention at that point including treatment for cancer. Why? Quality of life for his remaining time is more important to him.

The years of our life are seventy, or even by reason of strength eighty (Ps 90:10)
Beware the fantasy that medical breakthroughs can indefinitely prolong life (Ps 90:10; Luke 12:20; Ps 90:20). Current CDC statistics for anyone born in 1950s has an average life expectancy 69.1 years. Life expectancy was only 47.6 years for those born in 1900. For those born in 2015, life expectancy is 78.9 years. Don’t be decieved by what the medical community refers to as “outliers”.

The first principle for Christans to die well, is to resist the medicalization of death.

There are two interesting medical studies on terminal patients.

• There is a 2007 Study in the Journal of Pain & Symptom Management of 4500 medicare patients with a terminal diagnosis and who died within 3 years. Researchers wanted to see if those who chose aggressive care lived longer than those who chose comfort care. Interestingly, those who chose Comfort Care lived an average of 29 days longer.
• In the Journal “Cancer” in 2016 are study results of terminal patients contrasting those who died in the hospital with those who chose to die at home. Those who chose home death lived an average of 13 days longer.

I leave you with this powerful video by Dr. Robert Macauley.

Part 4 is here