What is more, the case underscores how badly the Church needs a language and a theology, as Hauerwas says, that provide us with the courage and skills to face our own and others’ deaths without weaving false webs of personal significance.
A community that has accompanied Jesus through Gethsemane, his trials, crucifixion, death and resurrection, already possesses both the language and the theology to face death without evasions devised to hold on to physical life at all costs. Before we speak of that, however, we should review some salient points regarding this tragic case.
Terri Schindler grew up in a devout household but did not become a practicing Roman Catholic, as her parents were. Either before or after her marriage to Michael Schiavo, she developed a severe eating disorder that led to an electrolyte failure and cardiac arrest. She never regained consciousness and was later diagnosed as being in the persistent vegetative state (PVS). That diagnosis meant a permanent, open-eyed coma in which the lower brain centers, located largely in the spinal column, continue to function, supporting breathing and other vital functions, even waking and sleeping, but the higher brain centers are dead and cannot be recovered. The frontal cortex and other parts of the brain that are the organic base for consciousness and processing perceptions are irretrievably lost. Indeed, six years after Ms. Schiavo entered the persistent vegetative state, CT scans showed that those centers of her brain had deteriorated and the space was filled with fluid. That was the point at which her husband petitioned to stop the artificial nutrition and hydration that was keeping her body alive. The guardianship court agreed with him that that is what Ms. Schiavo herself, if she were capable, would request under the circumstances. Then the legal and political struggle began.
A review of that affair is not necessary. More to the point is what moral voice those who are grounded in the theology of Holy Week and Easter should bring to the public discussion. My interpretation derives both from 35 years as a pastor-theologian and from 35 years immersed in the dynamic bioethical reflection and consultation of a medical school and teaching hospital.
When we go on a pilgrimage reflectively and faithfully through Holy Week, the Christian community learns deep truths about purposefulness, trial, endurance, and death. Raymond Brown suggests that one reason the passion narratives were recorded in such detail, even though much of it was not an eyewitness account, is that they served as a “how to do it” manual for Christian communities enduring trial and persecution of their own. The passion of Jesus was the prime example for Christians of what it means to bear faithful witness even unto death. From the passion narrative they learned—and we learn—that mere survival is not the goal of human life. When that truth is grasped, then one is free to use one’s life boldly and lay it down willingly when one’s witness is finished. W. H. Auden said it poetically: “And life is the destiny you are bound to refuse until you have consented to die.”
At our church’s Tenebrae service on Good Friday, after Jesus’ last words on the cross are read and the last candle is put out, we read a prayer written by Alan Paton. He published it in 1968 when he was taking risks to oppose apartheid in South Africa.
Lord, give me grace to die in Thy will. Prepare me for whatever place or condition awaits me. Let me die true to those things I believe to be true. And suffer me not through any fear of death to fall from Thee.
Lord, give me grace to live in Thy will also. Help me to master any fear, any desire that prevents me from living in Thy will. Make me, O Lord, the instrument of Thy peace, that I may know eternal life. Into Thy hands I commend my spirit.
That is a prayer of purpose and release. The moral truthfulness of the prayer is that it understands that life is to use—to use for faithful witness. It is not an end in itself. When physical life is seen as an end in itself, that is idolatry and the idol is the body. Jesus, the pioneer and perfecter of our faith, did not leave us that example for the race that is set before us (Hebrews 12:1-2). The cross removes from our sight any notion of “sanctity” when the object is the human body alone.
James Gustafson introduced me to the term ‘physical fundamentalism.’ He applied it to the point of view that locates the value of human life in the biological unit and invests the body with absolute value. If that were so, then Martin Luther King Jr. should never have gone to Memphis, knowing the risk to his life—and Jesus should never have gone to the cross. God’s action in Christ makes it clear that the spirit which Jesus commended to his Abba on the cross, and the spirit that led King to Birmingham and to Memphis, is a spirit (a nephesh, a life) that transcends the dust of the earth, the purely physical, and that death does not defeat it. What a contrast to the sad spectacle enacted in the courts and Congress of the United States in recent weeks.
And Easter teaches us that good can come of the saddest events. No one could fail to empathize with Ms. Schiavo’s parents as they grieve their daughter. Yet such times as these are when parents most need a moral community around them to remind them, in their grief and struggle, that it is possible to face our death and others’ with faith and courage and without denial.
The good I hope for in this sad episode in our national life is that the public sees more clearly the realities of sickness and death and learns to take responsibility for actually planning for death. Surveys show that only about 33% of Americans have filled out an advance directive. When we are not busy denying our mortality or trying desperately to keep a body functioning after the capacity for awareness, value, and love have fled, then we find the freedom to face our death responsibly. When we are not loudly protecting a “right to life,” then we may hold in balanced view God’s gift of eternal life. In this frame, one is empowered to live boldly and to plan for death with stewardship in mind. Stewardship: not to use a disproportionate share of common resources to hang on when it is time to lay life down; not to complicate the grief of loved ones with unfinished business; not to leave important medical and legal decisions un-addressed. I hope the Schiavo case raises the level of awareness of us all to these personal responsibilities.
If I were addressing the medical community about this case, I would remind them of the “technological imperative”—because something can be done it should be done. That is a lie. Of course it is possible to keep individuals alive beyond their biographical lifetime, sometimes for many years and at great expense. Because it is possible does not mean it should be done. I would also remind physicians, spouses and parents and other surrogate decision-makers, that we need to be honest about when we are treating the patient and when we are really treating ourselves. Medical mischief is afoot when the treatment is no longer in the best interest of the patient, but is serving some need, guilt, or unresolved issue of our own.
Terri Schiavo was in my mind when I sang on Good Friday, “O make me thine forever; and should I fainting be, Lord, let me never, never outlive my love to Thee.”
Albert H. Keller, a Presbyterian Minister of Word and Sacrament, is Associate Professor of Family Medicine (Ethics) at the Medical University of South Carolina. He also serves as pastor of the Circular Congregational Church, UCC, in Charleston, S.C.
Notes:
Alan Paton’s prayer is from Instrument of Thy Peace: the Prayer of St. Francis, The Seabury Press, 1968, p. 120.
Here is a resource for people to take responsibility for planning end of life care: Lance Davis and Albert Keller, At the Close of Day: a Person-Centered Guidebook on End-of-Life Care. This is just published and can be ordered from the web site (which also has up-to-date advance directives from all fifty states available free for download): www.atthecloseofday.com.
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