Talking About Dying

Have you ever considered your own death? . . . How do you expect to die?

These were the introductory questions that confronted participants in an adult Sunday school class entitled, "A Good Death: How Our Christian Faith Shapes Our Understanding of Dying and Death." The class goal was to help participants wrestle with how their faith and theology shape their understanding of dying and end-of-life decisions (EOL), as well as to explore how United Methodist resources guide us on these issues.

The class participants took a pre-test that gave an indication of their attitudes about dying before taking the class and what brought them to this discussion. Of the thirty participants, 60 percent defined a "good death" as "to die while sleeping." The next most popular response was "to die without being sick." Only a few people considered dying in the hospital with "everything being done" as a good death, and no one chose dying after a chronic illness as a good death.

While these responses are fairly consistent with what the EOL literature suggests that most people consider a good death, these views are in direct conflict with the national picture of how people actually die. In general, most of us will die after an illness or hospitalization. If there are no EOL plans in place, often death comes unexpectedly in the hospital setting after an acute medical crisis associated with a chronic medical condition (cancer, heart disease, complications of diabetes, and so on).

In general, we all seem to have an idea of what we'd like our "dying process" to look like, but rarely do we have the things in place to help it happen that way. What might these things be? The first thing that comes to mind are legal documents, such as a living will or a healthcare power of attorney. While these documents may be helpful, the best thing you can do is discuss your views on EOL care with your loved ones. This talk is the hard part, but it is the greatest gift you can give yourself and your loved ones. It may also create a space for your loved ones to share their EOL requests.

As a people that serve a crucified and risen Savior, Christians should lead the way on this topic. Yet, so many Christians are reluctant to engage in discussions about suffering and dying. We often wait until medical professionals confront us with a life-threatening diagnosis to consider how we want to die.

Ironically, early medicine grew out of the Christian community's hospitality practices. Over time, with a shift in our worldview that embraced science over religion, medicine became a very exact science with little room for religious mysteries of hope, faith, and prayer. Traditionally, the goal of medicine has been to cure and continue to treat a disease until every option has been explored. For many people, anything short of this approach is giving up or unethical, and participation in hospice is often viewed as being resigned to death.

In reality, given today's medical technologies, it is sometimes more ethical to make decisions not to start some treatments than to keep a person alive indefinitely through artificial means. Hospice and palliative care give the patient the option to treat the disease symptoms and have comfort care so she can continue to make the most of each day until her death. Hospice is an integrative approach to the "dying process" that addresses the medical, emotional, psychosocial, and spiritual needs of the patient and family in the "in-between time." In many ways, we Christians can link this living after a terminal diagnosis and before death with our theological notion of living between "the already and the not yet."

In general, most of us assume that death is a single act — one minute we're alive and the next we're dead. But through the groundbreaking work of Elizabeth Kübler-Ross in the 1960s and the death and dying movement, we have begun to realize that much happens as we die. While death, by definition, is the cessation of life, it is also a process that includes myriad physical, emotional, psychosocial, and spiritual dimensions of a person and his or her support system. And the church, as community and as the body of Christ, plays a key role in this process.

I believe the Holy Spirit is moving to call us back to our role in the dying process as a community of support and presence with people in their pain and suffering, and as a community that bears witness to a hope beyond this life — a hope that nothing can separate us from the love of God in Christ Jesus (Romans 8:35-39). Christians (who believe that Christ overcame death, sin, and the grave) should be leading the movement to address the spiritual needs of the dying. We believe in a God of eternal life or, as Paul told the Corinthians:

The trumpet will sound, and the dead will be raised
imperishable, and we shall be changed . . . then
shall come to pass the saying that is written:
"Death is swallowed up in victory."
"O death where is thy victory?
O death, where is thy sting?"
The sting of death is sin, and the power of sin is the
law, But thanks be to God, who gives us the victory
through our Lord Jesus Christ. (1 Cor. 15:52-57)

When was the last time you preached about death from the pulpit or led a study on death and dying? Have you ever looked at the narratives of the patriarchs' deaths or considered how Jesus prepared for his death? How do these lives serve as models for our living and dying processes?

As Christians, we should spend much time preparing for our dying while we continue to live in faith and hope as a community of presence that believes in a resurrected Christ and that anticipates our full redemption through Christ's return and the final feast of the lamb. Thanks be to God!

The Reverend Carolyn Burrus is a United Methodist Probationary Elder in the North Carolina Conference and a Hospice Chaplain appointed in Extension Ministries under Endorsement by the UMEA. She has a specialization in End of Life Care and Ministry through Duke University's Institute for Care at the End of Life and Duke Medical Center's Pastoral Care Department. This article first appeared in the Spring 2005 issue of Center Sage.