Hope in the Time of Medicalized Death
Moderator-
Farr Curlin, M.D., Duke University
Panelists -
Joshua Connor, MA, Ph.D. Student, University of Chicago
Daniel Strand, Arizona State University
Michelle Harrington, University of Chicago
In a provocative chapter, “Care of the Dying in America” (in Prozac as a Way of Life, eds. Carl Elliot and Tod Chambers, (Chapel Hill: University of North Carolina Press, 2004) Jewish bioethicist Laurie Zoloth probes the connection between widespread antidepressant use and the cultural norms and expectations that appear to necessitate their broad consumption. She proposes that SSRIs are prescribed to short-circuit the despair that is endemic to the mature human condition: responsible adults must live in the shadow of mortality and to the extent that antidepressants reify an existence in which grief and despair are pathologized or rendered optional rather than understood as an integral part of life, persons and communities lose the capacity to shoulder the burdensome responsibilities that caring for others entails. She equates the contemporary pursuit of happiness with a “flight into childhood,” where the aspiration to unencumbered youthfulness encourage us to eschew intergenerational and sacred obligations, particularly as they relate to aging and dying.
After twenty years of working in Toronto palliative care services, Stephen Jenkinson makes an analogous argument: he claims that the practice of bolstering hope in dying persons and the aim of palliative care to eradicate depression among this population makes it all but impossible for persons to do their own dying. The “death trades,” which he takes to include the revolving door of increasingly futile medical treatments, as well as palliative care and hospice in so far as they cloak the realities of human finitude, grief, and guilt, foster cultural conditions in which requests for terminal sedation and physician aid-in-dying continue to increase. The medicalized ethos of “cope, hope, and dope”-- (offering nearly limitless interventions, holding out hope for “more time,” and increasing dosages of opiates, respectively) forms a trifecta, he argues, for ensuring that individuals will not actually face their own deaths, and in turn guaranteeing that younger generations will miss the opportunity to witness their elders dying wisely and well. (Stephen Jenkinson, Die Wise: A Manifesto for Soul and Sanity (Berkeley: North Atlantic Books, 2015)
We propose to consider the meaning of ‘hope’ as it bears upon how we die in an increasingly medicalized culture. The twentieth century saw tremendous changes, as medicine grew in power and scope, while religious affiliation weakened and declined throughout much of North America. These demographic changes, mirrored by shifts in the sociology of medicine, have arguably not ushered in a more pluralistic approach to care at the end of death but a narrowing in the kind of hope that is available in the hospital ward, namely, the hope for a medical cure and, barring that, relief of suffering. In the absence of thicker convictions and the social milieus to support them, it is no surprise that the medicalization of death, which brings with it its own biopsychosociospiritual reaches, should fill the gap left by the breakdown in religious tradition.
In this this transformed cultural space, religious thinkers face a number of challenges, among them the need to meditate on the how our spiritual practices of dying are connected to the existential shape of our hopes, individually and culturally, as well as how religious traditions can work concretely in the context of contemporary medical practices to bring both medicine and death into a larger context of communal spiritual practices.
Spiritually, there is reason to think something has gone wrong. The Abrahamic religions, the Greek and Hellenistic philosophical schools, as well as Eastern traditions such as Zen Buddhism agree on at least one thing: death is a formative moment within spiritual life. Socrates, on the morning of his execution, claimed that the lover of wisdom need not fear death and indeed philosophy is a “continual practice in dying and death” . The Rabbis, meditating on the command to love God with all your soul, found in these words a metaphor for death as spiritual self-surrender and in the art learning to die as the shape of a hope beyond life. For St. Peter, the Christian is born again to a living hope through the resurrection of Jesus Christ from the dead, to an inheritance that is imperishable, undefiled, and unfading, kept in heaven for you…” (I Peter, 1:3-4) We find in these brief examples an intimate connection between the acceptance of death, spiritual development, and the cultivation of a radical form of hope. Our panel of religious ethicists will offer historical-comparative, practical theological, and liturgical lenses for reimagining the relation between medicine, religion, and dying in North America.
Our first panelist will approach the contemporary realities of religious and cultural pluralism through an analysis of the technologies of death and their corresponding virtues in Late Roman Antiquity. An Augustinian critique of the Stoics’ excessive desire for control, fear of suffering, and high regard for suicide will be contrasted with early Christian hopes in order to illuminate the starkly different conceptions of life that coexisted during that time. Should Christians bring such a markedly different take on questions of death, dying, and ending one’s life today? If so, how should the hope born of religious conviction shape how Christians engage medicine at the end of their lives?
Our second panelist will use the work of practical theologian Don Browning to examine the interplay between religion and the healing sciences. Browning was attentive to the concept of “health,” especially in its psychoanalytic and moral dimensions. He observed that the disciplines of care—pastoral, medical, and psychological—had become divorced from their religio-ethical contexts. “Although Jesus is said to have performed miracles of health, offering health in this world has never been at the core of Christianity or, for that matter, the other Abrahamic religions of Judaism and Islam. Bringing to maturity loving and self-giving persons has been the primary concern of Christianity, whether or not this contributes to health and well-being” (Browning, Reviving Christian Humanism, 44). This panelist will attend to the hope of religious and moral maturity that may be fostered by religious communities. In particular, how might religious persons analyze the current contexts of dying in light of what they imply about the ends and goals of human life? Can religious communities craft, through discourse with their religious texts and traditions and through more intentional engagement with their rituals and practices, a more faithful way of dying?
Our third panelist will place the Jewish philosopher Franz Rosenzweig’s meditations on death and hope in conversation with recent research on psychedelics and depression among the terminally ill. Rosenzweig, in a midrash on the Song of Songs’s assertion that ‘Love is as strong as death’ (8:6), reads the Jewish liturgy as an art of dying that fosters a consciousness of love, one might say an 'altered state of consciousness', which allows the Jewish soul to perceive death within an expanded horizon of redemptive hope. This panelist will explore Rosenzweig’s account of ‘soul expansion’ and its resonances with how the terminally ill have described their own expansive experiences in the controlled use of psychedelics. How do such techniques differ from antidepressant use among the dying? How can such expansive experiences help us develop a sense of mystery and hope within the process of dying?
Farr Curlin, M.D., Duke University
Panelists -
Joshua Connor, MA, Ph.D. Student, University of Chicago
Daniel Strand, Arizona State University
Michelle Harrington, University of Chicago
In a provocative chapter, “Care of the Dying in America” (in Prozac as a Way of Life, eds. Carl Elliot and Tod Chambers, (Chapel Hill: University of North Carolina Press, 2004) Jewish bioethicist Laurie Zoloth probes the connection between widespread antidepressant use and the cultural norms and expectations that appear to necessitate their broad consumption. She proposes that SSRIs are prescribed to short-circuit the despair that is endemic to the mature human condition: responsible adults must live in the shadow of mortality and to the extent that antidepressants reify an existence in which grief and despair are pathologized or rendered optional rather than understood as an integral part of life, persons and communities lose the capacity to shoulder the burdensome responsibilities that caring for others entails. She equates the contemporary pursuit of happiness with a “flight into childhood,” where the aspiration to unencumbered youthfulness encourage us to eschew intergenerational and sacred obligations, particularly as they relate to aging and dying.
After twenty years of working in Toronto palliative care services, Stephen Jenkinson makes an analogous argument: he claims that the practice of bolstering hope in dying persons and the aim of palliative care to eradicate depression among this population makes it all but impossible for persons to do their own dying. The “death trades,” which he takes to include the revolving door of increasingly futile medical treatments, as well as palliative care and hospice in so far as they cloak the realities of human finitude, grief, and guilt, foster cultural conditions in which requests for terminal sedation and physician aid-in-dying continue to increase. The medicalized ethos of “cope, hope, and dope”-- (offering nearly limitless interventions, holding out hope for “more time,” and increasing dosages of opiates, respectively) forms a trifecta, he argues, for ensuring that individuals will not actually face their own deaths, and in turn guaranteeing that younger generations will miss the opportunity to witness their elders dying wisely and well. (Stephen Jenkinson, Die Wise: A Manifesto for Soul and Sanity (Berkeley: North Atlantic Books, 2015)
We propose to consider the meaning of ‘hope’ as it bears upon how we die in an increasingly medicalized culture. The twentieth century saw tremendous changes, as medicine grew in power and scope, while religious affiliation weakened and declined throughout much of North America. These demographic changes, mirrored by shifts in the sociology of medicine, have arguably not ushered in a more pluralistic approach to care at the end of death but a narrowing in the kind of hope that is available in the hospital ward, namely, the hope for a medical cure and, barring that, relief of suffering. In the absence of thicker convictions and the social milieus to support them, it is no surprise that the medicalization of death, which brings with it its own biopsychosociospiritual reaches, should fill the gap left by the breakdown in religious tradition.
In this this transformed cultural space, religious thinkers face a number of challenges, among them the need to meditate on the how our spiritual practices of dying are connected to the existential shape of our hopes, individually and culturally, as well as how religious traditions can work concretely in the context of contemporary medical practices to bring both medicine and death into a larger context of communal spiritual practices.
Spiritually, there is reason to think something has gone wrong. The Abrahamic religions, the Greek and Hellenistic philosophical schools, as well as Eastern traditions such as Zen Buddhism agree on at least one thing: death is a formative moment within spiritual life. Socrates, on the morning of his execution, claimed that the lover of wisdom need not fear death and indeed philosophy is a “continual practice in dying and death” . The Rabbis, meditating on the command to love God with all your soul, found in these words a metaphor for death as spiritual self-surrender and in the art learning to die as the shape of a hope beyond life. For St. Peter, the Christian is born again to a living hope through the resurrection of Jesus Christ from the dead, to an inheritance that is imperishable, undefiled, and unfading, kept in heaven for you…” (I Peter, 1:3-4) We find in these brief examples an intimate connection between the acceptance of death, spiritual development, and the cultivation of a radical form of hope. Our panel of religious ethicists will offer historical-comparative, practical theological, and liturgical lenses for reimagining the relation between medicine, religion, and dying in North America.
Our first panelist will approach the contemporary realities of religious and cultural pluralism through an analysis of the technologies of death and their corresponding virtues in Late Roman Antiquity. An Augustinian critique of the Stoics’ excessive desire for control, fear of suffering, and high regard for suicide will be contrasted with early Christian hopes in order to illuminate the starkly different conceptions of life that coexisted during that time. Should Christians bring such a markedly different take on questions of death, dying, and ending one’s life today? If so, how should the hope born of religious conviction shape how Christians engage medicine at the end of their lives?
Our second panelist will use the work of practical theologian Don Browning to examine the interplay between religion and the healing sciences. Browning was attentive to the concept of “health,” especially in its psychoanalytic and moral dimensions. He observed that the disciplines of care—pastoral, medical, and psychological—had become divorced from their religio-ethical contexts. “Although Jesus is said to have performed miracles of health, offering health in this world has never been at the core of Christianity or, for that matter, the other Abrahamic religions of Judaism and Islam. Bringing to maturity loving and self-giving persons has been the primary concern of Christianity, whether or not this contributes to health and well-being” (Browning, Reviving Christian Humanism, 44). This panelist will attend to the hope of religious and moral maturity that may be fostered by religious communities. In particular, how might religious persons analyze the current contexts of dying in light of what they imply about the ends and goals of human life? Can religious communities craft, through discourse with their religious texts and traditions and through more intentional engagement with their rituals and practices, a more faithful way of dying?
Our third panelist will place the Jewish philosopher Franz Rosenzweig’s meditations on death and hope in conversation with recent research on psychedelics and depression among the terminally ill. Rosenzweig, in a midrash on the Song of Songs’s assertion that ‘Love is as strong as death’ (8:6), reads the Jewish liturgy as an art of dying that fosters a consciousness of love, one might say an 'altered state of consciousness', which allows the Jewish soul to perceive death within an expanded horizon of redemptive hope. This panelist will explore Rosenzweig’s account of ‘soul expansion’ and its resonances with how the terminally ill have described their own expansive experiences in the controlled use of psychedelics. How do such techniques differ from antidepressant use among the dying? How can such expansive experiences help us develop a sense of mystery and hope within the process of dying?