The doctors say she’s dying, but everything looks much the same. A plastic tube continues to supply every breath, various fluids continue to drip into her veins, her legs remain swollen, and an eyelid hasn’t fluttered in days, not even at the sound of her husband’s voice. He doesn’t think she’s dying, even if the doctors say she is.
He didn’t think anything could be worse than the drive until he tries to walk from the parking garage to the clinic. His bald, wrinkled head fades into the white walls of the waiting room, and he sits nauseous even though he hasn’t eaten in days. His steadfast wife is at his side, propping him up. An hour later, on the way home, he can’t remember much of what they had talked about, but he does remember that someone said he was dying.
A woman stands in line at the grocery store with a cart full of fresh fruits, vegetables, and various organic items promising wonderful health benefits. She’s going to turn this thing around. She’s going to beat this cancer! She looks at another woman an aisle over, hunched over her own cart, gray hair in disarray. Seeing another woman’s frailty gives her a chill – maybe she’s not going to beat this. Maybe she’s dying.
Death, Where is Your Meaning?
We all have some sense of what death is, though we may draw different boundaries. Metastatic cancer conjures images of one’s own funeral for some, whereas for others, dying is never acknowledged. Some may nonchalantly declare that everyone is dying while others deny the grave even with their last breath.
A Christian platitude, no less true for its insensitive overuse in times of great suffering, tells us that we die because of sin. Maybe we can’t trace someone’s death to a particular sin they’ve committed, but broadly understood, we all die because sin is in the world. Death is the curse of the Fall. True though this may be, it’s not something that helps people who feel the cold breath of death on their neck. It’s precisely because our ailments usually aren’t related to a particular sin that suffering can cripple faith. Suffering, death, health, and life resist us as we try to situate them within the over-spiritualized narrative of modern Christianity that has only uncomforting abstractions to offer. Suffering can’t be explained away.
It’s not only the chaos of suffering that erodes faith. The imposition of modern medical technology, as evidenced in the three aforementioned vignettes, does its work too. When is someone actually dying? Confusion about dying is only a mote cast from the larger heap of ash that has become our understanding of health. Is it healthy to have a certain laboratory value, or does health mean something more? Suffering unravels everything one takes for granted, including health and dying, either because of afflictions wrought by illness or by the treatment itself. James Davison Hunter, in To Change the World, calls this dissolution, which is (p. 205):
…the deconstruction of the most basic assumptions about reality. … The problem is this: when the objectified and shared meaning of words is undermined, when we no longer have confidence that words signify what we thought they signified, then it is possible to impute any meaning to words one desires. And if words can mean anything, then they have no intrinsic meaning or at least no possibility of a common meaning. They only mean what we say they mean. There are no fixed points of reference.
Suffering itself is dissolution. Suffering, like what Allen Verhey observed of death, threatens to dissolve the relationships between oneself and their body, their community, and their God. Terribly, it’s sometimes successful. Without those moorings, how can we have confidence that other things signify what they once did? Where is the frame of reference for discerning the boundaries of life and health, meaning and purpose?
A Stolen Faith
In the midst of such upheaval, one may fall back on the basic understandings of how things should work: breathing is good, heartbeats are good, numbers trending in the right direction are good. Families nod at the bedside of their comatose loved one, exclaiming, “Their vital signs look good!” That’s good, right? The vital signs are, after all, vital. Behind the curtain of life-sustaining therapies, though, organs fall one by one. Healthy-appearing numbers are heaped over someone who is otherwise dying (if only we knew what dying was).
If breathing is good, then the ventilator is good, or, at worst, neutral. If heartbeats are good, then the defibrillator is good, or, at worst, neutral. So continues the intuitive valuation of all the medical technology that can be applied to human bodies, which is adept at intervening on physiology and moving numbers in a certain direction for a while. Of course, breathing and heartbeats can be good. However, without a broader context in which to situate those vital aspects of health, they become ends unto themselves – breath is good merely for breath’s sake. Jean-Claude Larchet, relying on the early Church Fathers, arrives at a similar conclusion in The Theology of Illness that there’s more to health than its mere components (p. 55-56):
It is true that physical health corresponds to the normal state of human nature … and for that reason health can be considered as good in itself. Nevertheless, from another point of view health is worthless to the human person – it does not constitute a true good but is only good in appearance – if it is not used well, that is, if it is not used with an aim toward the Good: to fulfill the commandments of Christ and to glorify God. This is why St Basil declares: “Insofar as it does not render good those who possess it, health cannot be counted among those things that are good by nature.” In fact it is evil if it contributes to making a person indifferent to his salvation, keeps him away from God by giving him the false impression that he is self-sufficient, and bestows on him that strength of the flesh which actually weakens, rather than giving him that weakness in which God reveals himself, which constitutes true strength (2 Cor 12:9-10). Health is an even greater evil if it is used to give free rein to the passions, thereby becoming an instrument of iniquity (Rom 6:13). “Know then,” St Gregory of Nazianzus counsels us, “how to despise an insidious health that leads to sin.”
One need not see death coming fast over the horizon to make health an idol. Even those who are healthy, in taking their vitality for granted, idolize health. However, where the aim of medicine bends toward maintenance of physiology, the Christian risks binding up their faith with the technology itself, which is one manifestation of the idolatry of health. Such an amalgamation may have more spiritually formative power than the practices of the Church (like prayer) and the testimony of the Bible. In this way, the Christian’s faith is stolen by the technology that too often promises more than it can offer.
“Do everything. We’re hoping for a miracle.”
The promises of technology within medicine align with the promises of false gospels outside of medicine. Tens of thousands of people give their time, money, and their faith to televangelists and celebrity authors who tell them that if they just believe harder and give more, they will be healthier and wealthier. All of this is to wrest some bit of control back from the hands of God, as Kate Bowler wrote in the New York Times:
The prosperity gospel popularized a Christian explanation for why some people make it and some do not. They revolutionized prayer as an instrument for getting God always to say “yes.” It offers people a guarantee: Follow these rules, and God will reward you, heal you, restore you.
Bowler, a Duke University professor who studied the prosperity gospel and then was herself diagnosed with stage 4 colon cancer at the age of 35, remarked on how destructive this idol is:
The prosperity gospel holds to this illusion of control until the very end. If a believer gets sick and dies, shame compounds the grief. Those who are loved and lost are just that — those who have lost the test of faith. In my work, I have heard countless stories of refusing to acknowledge that the end had finally come. An emaciated man was pushed about a megachurch in a wheelchair as churchgoers declared that he was already healed. A woman danced around her sister’s deathbed shouting to horrified family members that the body can yet live. There is no graceful death, no ars moriendi, in the prosperity gospel. There are only jarring disappointments after fevered attempts to deny its inevitability.
The prosperity gospel has taken a religion based on the contemplation of a dying man and stripped it of its call to surrender all. Perhaps worse, it has replaced Christian faith with the most painful forms of certainty. The movement has perfected a rarefied form of America’s addiction to self-rule, which denies much of our humanity: our fragile bodies, our finitude, our need to stare down our deaths (at least once in a while) and be filled with dread and wonder. At some point, we must say to ourselves, I’m going to need to let go.
The prosperity gospel is easy to dismiss when it’s portrayed in such a flamboyant form, but it should never be taken lightly. Under the threat of suffering and death, we’ll attempt to leverage whatever we can to get things to go our way. A less dramatic variety of the prosperity gospel is maybe more pervasive: moral therapeutic deism. This is the cultural phenomenon described by Christian Smith marked by belief in a god who stays pleasantly distant except when needed. We summon its favor by doing good things. Moral therapeutic deism is no less avaricious than the prosperity gospel in speeding past the Giver to grasp health.
With attractions like the prosperity gospel and moral therapeutic deism in our cultural milieu, and when the medicines, the machines, the conversations, and the interventions all bend toward keeping air moving in and out of the lungs, urine flowing out of the body, blood circulating through the heart, and so on, why wouldn’t a spiritual practice like prayer serve a similar function? In this environment, spiritual practices are transformed into medical technology. Dissolution, just like in chemistry, allows for the creation of new bonds.
Therefore, it’s no surprise that when technology fails to achieve the desired effect, a Christian may react like their very faith has failed. As a palliative care physician, I have seen this time and again, as families of faithful Christians insist we “do everything,” even if “everything” doesn’t actually help someone live longer or better in the face of tremendous suffering and impending death. Faith becomes bound up in technology, and the failure of technology becomes the failure of faith. Perhaps a failure of faith brought about the failure of technology? This is unfathomable. Some insist on continuing technology with the hope for a miracle to vindicate their faith. As long as the technology is working, faith seems to be working too. “Faith” is dissolved and recreated to mean some kind of mental power to influence the outcomes of worldly events. Severe and critical illnesses, and the medical technologies that attend them, dissolve the meanings of death and health. In the face of such dissolution, Hunter noted that one can assume a defensive posture which fosters an unwitting reliance on technologies that lure people away from faithfulness even as they claim to be faithful.
Living and Dying
Jesus has a word against such dissolution: “I am the resurrection and the life. Whoever believes in me, though he die, yet shall he live, and everyone who lives and believes in me shall never die” (John 11:25, ESV). At face value, Jesus appears confused. Is the one who believes in him going to live or die? To complicate matters further, he was speaking with people who were mourning the indisputable death of Lazarus. How could this corpse live again?
What if, though, in response to those who claim to be dying, Jesus offers a hopeful word of life? God made you and the world in which you walk and breathe! He’s not going to argue with you about whether you’re dying (that’s a given), but he’s going to remind you that you will live. Rather than empty death of meaning through dissolution, Jesus removes its sting (1 Corinthians 15:55). He acknowledges that there are some people who will never die in one important way even though everyone dies in some earthly way. These words must have sounded audacious to his listeners as Lazarus lay lifeless in a tomb. Come near to Jesus, where there is life.
For the person who lives with no care that they will someday die, what if Jesus also offers a word to them, too – a word of warning? You are going to die. Jesus doesn’t deny it. He will save you through it, but through it you must go, for he went through it too. Jesus tarried while Lazarus died, and despite his miraculous resurrection, Lazarus did eventually die again. The slipping of life through our fingers may be staunched for a time with poultices, potions, salves, and surgery, but eventually the last grain falls and we die. Neither ventilator, scalpel, or medication will save us in the end. Life is only ever found in God. Yet, near Jesus there is death.
When health is situated within the broader life offered by Jesus, it resists the dissolving power of medicalized suffering. This life is given to us by someone on the other side of the cross, and with this life comes its own cross. Carrying such a cross, we bear the tension created by his in-breaking Kingdom between the pain of what is “not yet” and the hope of what is “already.” It is just as Basil and Gregory declared: not all health is good health, not all breath is good breath, and not every heartbeat must be clung to like it is good in and of itself. By doing this, the gaze shifts from death to health. The ventilator (and all other medical technology), once used to desperately stave off death, can be appropriately situated within a broader story of how Christians understand what health is for – to love God and to love others. In that story, there may be limits to the use of medical technology if it no longer helps someone on this journey. There may also be uses of medical technology that help restore to loving communities those whom the world believes aren’t worth saving. The question of when someone is dying becomes less relevant, because the more important question of how someone will use their health, whatever bit of it they have, comes to the fore. Each assumes the dying role as they shoulder their crosses and follow after Jesus. If this is true for each one of us, then when we come together as the assembled Body of Christ, we can be inspired to use our health to love one another.
Death does not have the last word, nor should it even have the first. This is as true of our lives as it is of Genesis and Revelation. In Living Well and Dying Faithfully, John Swinton remarked, “End-of-life care finds its roots in the processes of formation that go on throughout a person’s life and that come together in quite particular ways to produce the individual’s unique experience of dying. For Christians, the place where end-of-life care begins is in the day-to-day practices of the Christian life as it is lived out in community with others.” Let’s live like we’re dying because Jesus calls us to die like we’re going to live.