Rabbi Marc Gellman writes about religion for Newsday.
Msgr. Tom Hartman, my best friend, died Tuesday evening after a very long illness. May God receive his soul among the holy and the righteous. (Read my eulogy to him at nwsdy.li/eulogy)
I wanted to ask you readers to think about and pray about some of the spiritual issues we face when death comes slowly to our doors. These issues go beyond Tommy, but they surely include him.
The main issue, really the only issue, is how to find a way to remove external impediments to death without actually hastening death by active intervention. Modern medicine can delay death in two ways, and only the first is spiritually noble. Medicine can delay death by actually healing the patient. This is real and true therapy and it is the obvious purpose of the medical arts. Cancers can be cured, potentially fatal traumas can be resolved and chronic illnesses can be managed. However, the same medical arts that can miraculously extend our lives can also pointlessly extend our dying.
The way to keep medicine within its therapeutic boundaries is palliative care. This, in part, means managing the dying patient’s with less pain without unnaturally extending their passing. This may mean removing hydration and nutrition while administering only enough opioid drugs to keep the patient comfortable and serene. This is why hospice is so useful and so holy. When a patient is transferred to hospice care, it is a clear and tacit agreement by all charged with patient care that the boundary between cure and care has been crossed. Such a patient is not beyond hope, but he or she is beyond the hope offered by medical science. If I were taking a survey of angels living here on earth, I would begin by counting hospice workers.
Many people whose loved ones are being kept alive when their bodies are trying to die become resigned to pointless medical treatment of their loved ones because they believe that God has not chosen to take them yet. The truth, as I see it, is that God has chosen to take them, and we are thwarting God’s plan.
The unnatural prolongation of dying is not, however, only the result of medicine’s power to treat without healing. It is also the product of a litigious society where defensive medicine is practiced in order to avoid litigation. Hospitals and physicians are rarely sued for doing too much.
Another reason for the intrusive prolongation of certain death is not found in the power of medicine or in the threat of litigation, but within our own burdened souls. I have seen dying patients who were pushed into premature death and, conversely, those who were made to endure life beyond their time to pass by families who have lost sight of the fact that the dying person’s passing is about the dying person — not about them.
Some families can understandably lose patience with a dying member who puts their lives on hold and interrupts the normal and pressing obligations of life. For them I pray for the spiritual insight that their care is a way to repay the debt of love. Their presence at the bedside is a way of showing that to the very end, the person was loved and embraced. It also gives them time to renew and strengthen family bonds that may have been strained by distance or petty disputes. Sudden traumatic death deprives a family of such closure and catharsis.
Conversely, some families may overly extend the dying of a loved one in order to make amends for care not given during life. Doing everything possible rather than just everything prudent and palliative during dying can become a futile attempt to compensate for not doing everything possible when death was not standing at the foot of the bed. Both these distortions of doing too little or doing too much are ultimately about the needs of the living, not the needs of the dying.
A rabbinic story that takes place in the 16th century, before medicine gained any real power to alter the parentheses of our life, still inspires me:
“The dying person is like a flickering candle and nothing should be done to extinguish the flickering flame. However, if there is a wood chopper outside the window of the dying person’s room whose noise is jarring the dying person into consciousness, one must silence the wood chopper because all one is doing is removing an external impediment to death.”
May we all have the love and courage to silence the wood choppers and give voice to our love and memories that cannot be silenced.