The Distinct Visions of Death in Secular and Christian Arts of Dying
Paul Scherz, PhD, Assistant Professor of Moral Theology and Ethics, The Catholic University of America
In the face of the widespread problem of medicalized dying, Atul Gawande and other doctors have attempted to rethink medicine’s approach toward end of life care so that patients can pursue their personal goals in the recognition of approaching death. Christian theologians have also attempted to address current problems in end of life care by recovering the ars moriendi, a tradition of Christian spiritual writing that aided the Christian in preparing for death and the process of dying. Arising in the aftermath of the Black Death, these how-to manuals were popular in both Catholic and Protestant circles throughout the Renaissance and early modern periods. Some scholars have suggested that secular medicine should look to this Christian tradition to create a secular art of dying that would encourage patients to embrace finitude and find resources in their communities to determine goals for end of life care.
While refocusing medicine on preparing for death is a salutary move, this paper will suggest that there are some fundamental differences between secular medicine’s vision of a good death and the Christian vision of dying well that should make Christians view this reconciliation with caution. This paper will argue that many writers encouraging a turn in medicine toward a preparation for death tend to adopt a vision of a good death from contemporary society and bioethics. This vision of death sees a patient surrounded by family and friends with no pain or spiritual distress, directing her care autonomously in line with her values until the last moment. It is an aesthetic of death based on the utilitarian medical goal of reduced suffering and the bioethical end of autonomy.
In contrast, the Christian ars moriendi did not focus on an aesthetic of death but thought a person died well only if she attained a particular end – eternal life. All else was subordinated to that end, with even bedside access restricted to the pious. This good death was not generally peaceful, but a last struggle with sin for which the dying needed remedies for temptation and faithfulness in the face of despair. This art did not try to prevent spiritual distress because such distress may be necessary for the sinner to repent or even the mediocre Christian to express true contrition. Through these painful struggles, the person would ultimately find true peace. Finally, it is not focused on one’s own will, but on God’s. It encouraged trusting that God brought about what one needed at the hour of death, even if that included the spiritual work of suffering or testing. The paper will conclude by suggesting that a medical art of dying could be helpful if it helps patients recognize death and embrace their tradition’s response, but it could also endanger the Christian art of dying if it prematurely soothes productive distress, numbs pain into unconsciousness, and encourages unguided autonomous goal setting.
In the face of the widespread problem of medicalized dying, Atul Gawande and other doctors have attempted to rethink medicine’s approach toward end of life care so that patients can pursue their personal goals in the recognition of approaching death. Christian theologians have also attempted to address current problems in end of life care by recovering the ars moriendi, a tradition of Christian spiritual writing that aided the Christian in preparing for death and the process of dying. Arising in the aftermath of the Black Death, these how-to manuals were popular in both Catholic and Protestant circles throughout the Renaissance and early modern periods. Some scholars have suggested that secular medicine should look to this Christian tradition to create a secular art of dying that would encourage patients to embrace finitude and find resources in their communities to determine goals for end of life care.
While refocusing medicine on preparing for death is a salutary move, this paper will suggest that there are some fundamental differences between secular medicine’s vision of a good death and the Christian vision of dying well that should make Christians view this reconciliation with caution. This paper will argue that many writers encouraging a turn in medicine toward a preparation for death tend to adopt a vision of a good death from contemporary society and bioethics. This vision of death sees a patient surrounded by family and friends with no pain or spiritual distress, directing her care autonomously in line with her values until the last moment. It is an aesthetic of death based on the utilitarian medical goal of reduced suffering and the bioethical end of autonomy.
In contrast, the Christian ars moriendi did not focus on an aesthetic of death but thought a person died well only if she attained a particular end – eternal life. All else was subordinated to that end, with even bedside access restricted to the pious. This good death was not generally peaceful, but a last struggle with sin for which the dying needed remedies for temptation and faithfulness in the face of despair. This art did not try to prevent spiritual distress because such distress may be necessary for the sinner to repent or even the mediocre Christian to express true contrition. Through these painful struggles, the person would ultimately find true peace. Finally, it is not focused on one’s own will, but on God’s. It encouraged trusting that God brought about what one needed at the hour of death, even if that included the spiritual work of suffering or testing. The paper will conclude by suggesting that a medical art of dying could be helpful if it helps patients recognize death and embrace their tradition’s response, but it could also endanger the Christian art of dying if it prematurely soothes productive distress, numbs pain into unconsciousness, and encourages unguided autonomous goal setting.