Dying With Dignity (2023)

DYING WITH DIGNITY

 INTRODUCTION

Y want to speak about a subject that is not very often discussed.  Yet, death is something that all of us will experience sooner or later, and that is the inevitable consequence of having been born.  I want to reflect about how we can help people, and ourselves, to die with dignity.

In April 2003, while I was a final year student at the Scottish Baptist College, I was a student chaplain for a few weeks at two big hospitals in Glasgow.  I was focused on the cancer wards of the Western and Gartnavel hospitals, where I was learning under the watchful eye of Reverend Stuart MacDonald, who was then the minister of Knightswood Baptist Church.  I was on final year placement from the Scottish Baptist College, and the placement was to help me to grow in understanding, it was for me to gain new experiences, and it was for me to develop my pastoral care skills in what would be a very demanding, and a difficult, environment.  When the placement ended, I would be required to evaluate my pastoral care skills from the placement, and I was to integrate biblical narrative, theological principles, and the practice of pastoral care.

In the environment of the cancer wards of two very busy Glasgow hospitals, I also had the opportunity to grow in understanding about the need for human beings to be able to live, and to die, with dignity.  I will always be grateful to the Reverend Stuart MacDonald for allowing me to be alongside him for that placement time, and for him trusting me to get on with being a student chaplain without him feeling the need for him to be always looking over my shoulder.  In the midst of wards of people who were suffering greatly with cancer of one kind or another, I wanted to be able to help them cope with life and impending death in any way that I could.

 JOHN

As a student chaplain on that placement, I usually went around one or more of the oncology wards in the mornings and spent time just being with the cancer patients, and talking with them as much, or as little, as they wanted to. As I approached one bed, I could see that a man, probably in his forties, had major scarring on his forehead. I introduced myself and he told me his name was John, though I have changed his name for the sake of confidentiality. John told me that he had already had surgery for a brain tumour, and that he was now awaiting the results of further tests so that the doctors could decide on their next course of action. We talked about his home, his family, and we explored the context of where he had come from to arrive at this point. I also shared about my own context and life experience, and why I was in the hospital, as well as discussing with John my personal call to pastoral ministry. John seemed to be reasonably hopeful that the doctors could do something good for him, and that he would be able to get back to his normal life in the near future.

I was back on that same ward a week later, and, for the first time, I met and talked with the ward Sister who had been on holiday the previous week, so I had not met her back then. We discussed issues related to people whose life was suddenly disrupted by the discovery of cancer. Sister spoke of how the control of your life can suddenly be wrenched from you by finding out that you have an inoperable brain tumour, and that you would therefore be dead within a matter of weeks. Though she did not name names, I knew who she was talking about and I said so to Sister, and I then related to her the conversation that I had had with John the week before. Sister then told me that John had effectively known that his situation was terminal as long ago as the week before I had actually met him. However, the final confirmation had been given to him in the last couple of days, and that he would be going home to sort out his affairs and to die.

I went out from Sister’s office, and I began my round of the ward. I had not been on the ward very long at all when, in the course of me walking between two sections of the ward, John and I almost bumped into each other. I looked in his eyes and I asked him how he was doing. Tears filled his eyes as he said quietly, “They’ve dealt me my cards.” I suggested we go to his bed and sit down together. We sat down together on his bed, but all he could do was tell me once again that they had dealt him his cards. I couldn’t say anything, and all I could do was to put my hand on his shoulder. A few seconds later, he excused himself because he said that wanted to go for a cry.

 LOOKING THROUGH THE GLASS

While I was a student hospital chaplain during that placement, I was very aware of the real tension between me being just a student chaplain who was on the wards to learn from others, and the fact that patients nevertheless often related to me as if I was a full professional who was competent to do the job, or else I wouldn’t be there at all. I was then, and I still am, very aware that I do not have all the answers. Indeed, I am certain that I have very few answers, if I actually have any answers at all. The close inevitability of death often causes in people an unparalleled awakening of a sense of fear combined with an unparalleled sense of panic in the person concerned. 

At a personal level, I had already had my own experiences of how people handled dying – not just their own terminal process, but also the final days of other people around them. This was true not only in my immediate experience of my own close family, but also in my observing how professional people handled people who were dying right in front of their eyes. In speaking about the many people who are professionally involved with the dying, Oden, in his book Pastoral Theology, said that ‘only the fact of death is dealt with, not its meaning.’ How, then, could I bring meaning to a dying human being? It is relatively easy for me to rehearse ahead of time what I might say when confronted with a person who is in a situation like that as was being experienced by John. It is altogether a different thing when you are suddenly face to face with someone who will soon die, and you did not anticipate the meeting.

When I found myself in just such a situation, I felt a helplessness to actually do anything, but I also had a real unwillingness to use words cheaply. I wanted rather to have what Lyall, in his book Integrity Of Pastoral Care, called the ‘grace in having nothing to say’. If I am truly honest, I also had an overwhelming desire not to be in that situation at all. Running away was not an option, however. I was there, and I had to be able to practise what Lyall called ‘support without interfering.’ Wilcock, in his book Spiritual Care of Dying and Bereaved People, addressed how I felt in that situation, when he said, ‘The addressing of our own helplessness is necessary to stop us running away, or taking refuge in false optimism, or withholding from the dying person permission to explore with us their fears and grief.’ But to give a dying person the permission to explore with me their fears and grief only finds true meaning if I, too, am exploring and knowing myself in the same way.

That is true because it is helpful for me to know what I am like in my inmost being, and to know by looking at who and what I am in the light of the Holy Spirit who shows me what I am truly like in her eyes. Would a dying person engage in that kind of self-exploration as I spent time with them? Surely it would be a little easier if the reassuring presence of the Holy Spirit can be sensed through my own openness and honesty? I must let the dying person know that I have not come to preach at them, that I am not there to convert them. No! Instead, the person needs to know that I am there to love them even as Christ loves them. I must try to work out what that looks like for the person that I am with. I do not want to threaten them, I do not want to interfere, and I want them to be comfortable with me.

In the light of even my own limited experience, I can understand why, in the face of terminal illness or death, evangelical hardness and legalism must give way to truly loving people as Jesus loves them. I can understand why loving people is far more important than winning converts; that being a true friend with people is much more important than preaching at them.  These words from the Church of Scotland’s ‘A Church Without Walls’ report are surely important here: ‘Here friendship is about commitment to each other (“No one has greater love than this, to lay down one’s life for one’s friends”) and openness with each other (“I have called you friends, because I have made known to you everything I have heard from my Father”).’ I can understand why so much of church does not touch people’s real lives, and I can also see why it does not help them when they are asking the serious questions of life and death. These questions are not only on the lips of the dying, but also on the lips of their relatives, too. It is easy to be trite, to be neat, and to be theologically clever; but where is my love? If people cannot share their lives with me, how will they ever share their death with me?

As a student chaplain, I was meeting some people who were caught up in what Nuland, in his book How We Die, called the system of ‘modern dying in the modern hospital’ where people slip towards their modern death. Yet, as Nulande said, if ‘a young doctor learns no more important lesson than the admonition that he must never allow his patients to lose hope, even when they are obviously dying,’ how much more must those of us who call ourselves Christians bring a real hope to the dying? Can I be short on answers but yet full of love for dying people? Could I be a person of hope for someone whom medical science now terms as a ‘hopeless’ case?

As I went out onto the hospital wards to do my rounds on each of the mornings that I was student chaplain, I would look through the windows of each section that I approached in order to get an overview of the patients who were in that room before I went in. This routine quickly became a habit. But so, too, did my inclination to think about patients, and I had to constantly remind myself that I was not in the hospital to see patients; I was there to meet with people who were in need of people who would accept them as people, and love them as people. Likewise, in a church context it is easy to have a system of pastoral care that treats people’s needs without ever truly drawing close to the people themselves. It is actually very easy to do. Someone presents their problem, you present a prayer, and YHWH presents an answer. Simple. I wish! But it does not always work like that. John taught me afresh that I, too, am a person who needs love, and that I will often find love as I give love.

John taught me afresh to try to value every individual member of the human race even as YHWH surely does. We can, of course, know what we ought to do; but knowing how to do it can be quite a different matter. When I met John, I met someone whose greatest need was to know love from someone who could be more than a friend during his time of great need. Though he may not have verbalised it in this way, he needed someone to love him. Someone who would love him not because he was terminally ill, but because he was a person in his own right. Though he may not have said in that way, he needed someone who would love him as Jesus loved him. Indeed, John almost certainly would not have verbalised it that way. Nevertheless, that is what he really needed. To accept him and to care for him as Jesus cared for him. Gone was the time for scoring theological ‘Brownie’ points or notching another convert on the hit list. For me in that situation, it wasn’t even important that I try to analyse what John was feeling or what he was going through; I just knew that he needed someone to be there and that I was there. Like Nuland, ‘I would listen more to the patient and ask [them] less to listen to me.’

In this student chaplain, John found a non-threatening person with whom he could share his profound sense of personal shock; I found someone with whom I could share my profound sense of personal love. John may have felt that the giving in our times together all flowed just from me to him, but I knew better than that. Switzer, in his book Pastoral Care Emergencies, spoke of the dying person’s need to express their feelings to others, but the man I was with had not yet been able to fully express his feelings even to himself. Therefore, he needed, and indeed he had asked for, the time and space to go and face up to his own feelings. At that moment, John was not able to personally come to terms with his situation, let alone to begin to sit down and think through the consequences for him and his family. 

As Switzer rightly said, ‘We are to move at their pace, not ours, with the degree of openness they desire.’ Yet, that is a difficult balance if, as Nuland said, the person does not want ‘to exercise their right to independent thought and self-determination – in other words, their control’, because they cannot yet face the truth of their own impending death and so they block out the news that they don’t want to hear and just try to live in a world of make-believe in which everything will be just fine. John had spiritual needs, but, in specific terms, those needs were largely unknown to him then. He was still speaking of cards being dealt to him by the doctors and possibly, to some degree at least, holding the doctors responsible for what was happening to him. Their ‘bad deal’ had given him ‘bad cards’, and perhaps it was, for him, the doctors who caught the brunt of it, for the game had turned sour. I think that it is a good, though not easy, practice to be honest with people about what medical science can or cannot do for them but, when it comes to the giving of bad news, how they are told and by whom is of critical importance. In my personal view, junior medical staff should not give senior news, and impersonal staff should not give personal news.

Switzer discussed the fact that some doctors refrained from being honest with their patients about their terminal illnesses because they did not want to ‘destroy their hope’, but my (very) limited experience causes me to dislike what he called a ‘temporary but needed denial’ because it suppresses the human instinct to face up to and to perhaps deal with what is happening to them. It also turns life into the embodiment of perception and, in so doing, it turns YHWH into the embodiment of theology. Everybody wants a good God who gives only good news, and no doctor wants to be the bad ‘god’ who is the bearer of bad news. I have observed that many doctors are exceedingly uncomfortable with the impending death of their patients and I can understand that because, as Oden pointed out, doctors ‘time-honored medical ethic centers upon sustaining life rather than dealing with death.’ Impending death spells out the fact that the doctors can do no more for the body. Nuland asked why, when doctors can do no more, they still keep up ‘the busy paraphernalia of scientific medicine, keeping a vague shadow of life flickering when all hope is gone.’ Yet, Nuland himself found that avoiding this busy-ness was easier said than done when his own brother was found to have a massively invasive cancer.

Hope of a cure may be gone, but there is still hope; the human doctors may not be able to do any more doing, but they can still be human beings. As Nuland said, ‘A promise we can keep and a hope we can give is the certainty that no man or woman will be left to die alone.’ To be a human being is to be in relationship with other human beings, for we are a human race, not merely a collection of individuals. My friends are valuable to me for who they are, and what they do is seen and known by me in the light of who they are. While Switzer does not explicitly say this, he does imply that what a terminally ill person needs most is a human being rather than a human doing. A dying person needs someone who will be right alongside them and who will be very careful in their use of words and deeds. But isn’t that also true for every person in every minute of every day of their lives, regardless of their circumstances? Surely church has often fallen into the trap of having members, but forgetting that the church is people – church should never be a mere institution.

To paraphrase Switzer: The first absolutely critical issue in terms of willingness and ability to work helpfully with other people is who we are as persons. Many factors of my life have made me what I am, and many people have contributed to my being as a person. Whether good and bad, right or wrong, I do not always know, for these things cannot always be clearly discerned. One thing only I know: I am me. But I know a second thing: YHWH is God. And I have discovered what Wilcock has called ‘windsurfing on silence’ as YHWH and I have been together in different situations, with sometimes both of us saying and doing nothing. I am a human being and YHWH is who and what they are, and we are together. 

For a few precious seconds, and with my arm resting on John’s shoulder, we windsurfed on silence together. Regardless of faith, or lack of, and as our bodies touched even so briefly and lightly, we were sharing Wilcock’s ‘grace without the weariness of negotiation or the fear of compromise.’ Human being simply but profoundly touched human being. My words with John had been very few, but there was a togetherness that words could easily have destroyed, if they had been used unwisely. 

I treasured the brief times that I had with John. I treasured the privilege of simply being human with him, and making no demands of him; I was simply being one human being with another human being. Through the average human being that I am, was another human being touched. What YHWH was doing in John I do not specifically know; neither do I know the seed that they may have planted in John. But I am certain that John would remember our brief times together, and I am equally certain that words could never describe the togetherness of human being to human being. Thank you, John.

THROUGH THE LOOKING GLASS

Whenever and wherever I am, I pray that YHWH will reach out and touch other human beings through me, and that I may not be obsessed with merely ‘getting results’. May I be ever focused to see and know YHWH’s touch to me from people who are not obsessed with ‘getting results’, but who just love people. I pray that YHWH will use others to touch me, and may they be near to me when it is my turn to ask the hard questions of life and death on my own behalf. For ask them I surely will. If not today, then tomorrow. The writers of the Psalms frequently asked YHWH many hard questions and often they did not receive any answers, but they often received YHWH who was and is the answer. May I, too, receive YHWH who is the answer. Jesus is the way, the truth, and life.

In whatever circumstances I find myself in the future, may all those who have known me also have known something of Jesus through me. May all those who received me have received something of Jesus. In him I live and move and have my being. My human being. May those who know me ever help me to guard against my relying on simple answers and mere formulae. May those who know me ever help me not to rely on my own wisdom.

Meeting John did not shake my confidence in YHWH the God of love, but rather it increased my love for YHWH who is love. I pray that I will never shirk from being with people who are struggling in life’s most difficult circumstances, and may those people remember my love, not my easy answers. Oh, YHWH, don’t let me be indifferent to the pain of others. Don’t let me turn my face away. Don’t let me hide. Don’t let me run away. Let me look into the eyes of the broken, of the dying, of the bereaved; and, in looking, let me care for them as you care for them. Don’t let me give false hope to the dying, but let me give them real hope that springs from eternity. Don’t let my heart grow cold to others.

May my unlimited love always be far more evident than my limited theology is. YHWH forbid that you, YHWH, should ever be reduced to being the embodiment of my theology. Keep me ever looking into your eyes, O YHWH; then I can look into the eyes of others. Keep me vulnerable, even as you are vulnerable. Let me, like Cassidy in his book Light From The Dark Valley, ‘reveal to people that they are lovable.’ Lovable to me, and lovable to you, YHWH. The lovable are valuable. Valuable to me, and valuable to you YHWH. As I meet suffering human beings, let me bring to them the love of the suffering YHWH.

Before I come to face my own death, before I make that awesome, holy journey for myself; and in order to care wisely for those who make it now, I need a bigger knowing of YHWH. I will both live and die better, if I know the sacred necessity of abandonment to YHWH and the gospel of grace. Doctors see patients and they treat diseases; but I want to care for people. Each and every person is loved by YHWH. For YHWH is love. YHWH, let me be love. Nothing more, and nothing less. Let me, like Clark, in his article Ministering To The Dying, ‘represent a quality of care and love which brought the universe into being and which even now surrounds each needy soul.’ By this may people know that I am your disciple. By this may John have known that I was your disciple. By this may John have known dying with dignity.

BIBLIOGRAPHY

Cassidy, S, Light From The Dark Valley, (London, Darton, Longman + Todd, 1994)

Clark, G L, ‘Ministering To The Dying’, The Expository Times, Vol 92 No. 6, March 1981, pages 164 – 166

General Assembly of the Church of Scotland, The Report of the Special Commission anent Review and Reform, ‘A Church without Walls’, available in November 2002 on the Internet from: www.churchwithoutwalls.org.uk

Lyall, D, Integrity of Pastoral Care, (London, SPCK,2001)

Nuland, S B, How We Die, (London, Vintage, 1997)

Oden, T C, Pastoral Theology, (San Francisco, Harper, San Francisco, 1983)

Switzer, D, Pastoral Care Emergencies, (Minneapolis, Fortress Press, 2000)

Wilcock, P, Spiritual Care of Dying and Bereaved People, (London, SPCK, 1996)