A New Ars Moriendi to Address Physician-Assisted Suicide

If you live in a state that has not taken up legislation on physician-assisted suicide (PAS), beware. It is coming. PAS has become a volatile issue in state legislatures and the media.

Advocates for PAS typically present three arguments to promote its legalization: (1) to relieve the suffering patient of pain, (2) to relieve the patient from becoming a “burden” to their family, and (3) to give the patient the right to make his own choice regarding death. This last point is often described as “death with dignity.” For many on both sides of the fence, this is an emotional and painful issue. In a 1996 study led by E.J. Emanuel, two thirds of oncology patients and the public studied found that euthanasia and physician-assisted suicide was thought to be acceptable for patients with unremitting pain. However, in the group studied, PAS was least acceptable in cases involving burden on the family or when life was viewed as meaningless.

The Catholic Church has responded by pointing out the errors in the PAS thought process and reminding us of the inherent dignity each person has simply for being a child of God. This dignity is referred to as the Imago Dei. The Church points out two significant alternatives for consideration: (1) that proper pain management is available to eliminate pain in most patients and (2) it is ethically right and legal to withhold or withdraw treatment when it becomes burdensome or no longer effective.

The Church further explains that a patient or loved one should never feel that showing compassion or recognizing their dignity places a burden upon the family or caregiver. We are called to show compassion to those who suffer and keep the patient in our communal thoughts, prayer, and actions. Helping those with an illness or disability is simply imitating the love of Christ. One of the dangers of patients not wishing to be a burden is that they seek to end their lives out of a sense of loneliness or desperation. Depression or fear can never be the basis for taking such a significant action.

To claim the patient has the “right” to make their own choice regarding their death is to claim that one has full dominion over his own life, exceeding the dominion of the God who gave him life. Benedict Ashley reminds us in his book Living the Truth in Love that this thought denies that God will help us live life to the end and in such a way that even our suffering will contribute to our spiritual welfare and that of others. To many physician-assisted suicide advocates, anything that stands in the way with the patient’s free choice is a challenge to his personal dignity. Physician-assisted suicide is not freedom nor is it a choice in dignity. Pope St. John Paul II in his encyclical Evangelium Vitae reminds us that assisted suicide “involves the rejection of love of self and the renunciation of the obligation of justice and charity towards one’s neighbor, towards the communities to which one belongs, and towards society as a whole.”

Physician-assisted suicide differs from the decision not to employ extraordinary means to maintain life and allowing the disease or illness to take its natural course to death. Extraordinary means are ones that provide little benefit in helping the patient recover or to perform conscious human functions and, as such, do not justify the burdens it places upon the patient and those who must care for them. PAS is a choice to end life while ordinary means of care are still available to the patient.

Revisiting the Ars Moriendi
For the medieval Western Christian world it was the Ars Moriendi, or “art of dying” that guided views for the sick on death and dying. These works of Christian literature provided guidance for the dying and those attending them. The Ars Moriendi informed the dying about what to expect as well as prayers, actions, and attitudes that could lead to a good death and salvation. The works appear in Europe in the early fifteenth century and were popular well into the eighteenth century. The Ars Moriendi notes five temptations: (1) temptation against faith versus a reaffirmation of faith; (2) temptation to despair versus hope for forgiveness; (3) temptation to impatience versus charity and patience; (4) temptation to vainglory complacency versus humility and recollections since; and (5) temptation to avarice or attachment to family and property versus detachment.

The Ars Moriendi called for remembering Jesus and his dying, leading to a paradigm for dying well and faithfully. Theologians Brett McCarty and Allen Verhey disagree with its notion of death as a good by pointing out that we live and die in confidence that death does not have the last word but is robbed of its sting by the resurrection of Jesus.

While popular culture and most Christians today are not familiar with the Ars Moriendi, its context survives in today’s prayer books and ritual manuals such as “Ministration and time of death” in the Episcopal Church’s Book of Common Prayer. It seems what has been lost today is the sense of a guideline for the dying and their loved ones. We’ve lost our notion of dying a “good death” which has led society and the patient to resist death rather than fight for a “good life.” Physician-assisted suicide is a surrender to this latter notion when the good life is not so good anymore.

Changes in Dying
In one regard, it is surprising that death has gotten so much attention in our culture today. Death is no longer a subject that Americans like to talk about. However, from the moment of our birth each of us will come face to face with this issue—at some point we will all die. The difference now is that we are facing death differently than ever before. Before the invention of antibiotics, death was considered to be evenly spread among most age groups. Human beings could not control bacteria before our modern advances in public health. Today death is much more likely to occur in our elderly population and in a medical facility rather than at home. This radical change in dying is a modern invention. Less than a generation ago, a family member was likely to spend his last days at home. Now they are now more likely to die being hooked to a machine in a medical facility. Our society now relies on technology that enables people to live longer. In Jeffrey Bishop’s critical analysis of the medicalization of the dying process, The Anticipatory Corpse: Medicine, Power, and the Care of the Dying, he reminds us that “patients in the ICU often end up living lives perceived to be worse than death, with no hope of returning to a state of human thriving.” Society is telling us there is no value here—so end it. Yet, there is value in all life and it is up to us to make this view mainstream again.

The Christian Art of Dying
In his book The Christian Art of Dying: Learning from Jesus, Allen Verhey suggests that “Dying well in America is hard work. And American Christianity has not helped much.” Verhey challenges us to a new Ars Moriendi, one that models itself on the life, death, and resurrection of Jesus Christ. By not simply focusing on the death of Jesus during periods when we experience death, but by engaging his whole ministry, we can open ourselves, and especially our younger generation, to possibilities of a shared Christian story. There are particular practices in scripture, as Verhey notes, that do this. When we can open Millennials in particular to see our Christian community as a gathered response to the call of God, conversations such as why we need to avoid physician-assisted suicide move away from conversations about death to conversations about life. Engaging Millennials to be open to scripture and thus, opening themselves to the story of God’s love and grace, their thoughts join with the Christian community. By opening Millennials to pray as a community they will learn to entirely turn toward God. In the sacraments, they will be called to faithfulness and to trust and hope in God’s promise. The hot button issues of today become less about suicide and more about moving through the tasks of dying as well as enabling the community to aid and attend to the patient.

Verhey suggests that some other traditional Christian practices around dying, such as mourning and comforting, need to be renewed or recovered. This past year a close friend of my daughter died in a car accident. My daughter was devastated. In her grief her mother and I came to realize that she did not know how to mourn. She went to the wake but would not attend the funeral. She was afraid of the goodbye. As Verhey points out, the Millennial generation relates to the death but does not move with Jesus to his resurrection. Mourning is only part of the issue. My daughter has been stuck in her goodbye when the faith she was raised with failed to reach her heart and help her see her friend’s new “hello” in a life after death.

Scripture reminds us “Blessed are those who mourn for they will be comforted” (Matt 5:4). This is a call for us to be eager in celebration so that those who suffer are not alone or abandoned. God is with them. Those who mourn may not be comforted by talk of the resurrection. Hope for the resurrection does not easily fill the void left by the departure of the dead. Those who mourn are in need of a ministry of presence; being with them in their time of sorrow. They are encouraged to take small steps in returning to life and realizing that a life can be lived in the absence of a loved one, owning their wounds, and sharing their feelings. God promised to bless those who mourn. Scripture is an all-encompassing vision of the future, God’s future. The faithful Church community supports not only the dying, but those who go through parts of the journey with them.

The Millennial generation needs to see the funeral as a place to acknowledge their grief and proclaim hope in the resurrection. We remind each other that our baptism is a participation in the death and resurrection of Christ. Funerals do not deny death; they celebrate life. Yes, it is an exit from this earthly world, but it is an entrance into the eternal one. It is our Easter after our Good Friday. It is once again a time together as a community to celebrate our faith in God. Verhey notes the funeral and our attendance is always a time to proclaim, “God has won and will win the victory over death.”

The response to issues such as physician-assisted suicide can be addressed in our modern Ars Moriendi where our faith stresses the interconnectedness of human existence, which is continued in our participation in the dying process rather than the avoidance of it. Communal virtues such as hospitality and compassion are reflected in our gathered community. Prayer for Millennials must move from “words on Sunday” to relating themselves as part of a community of “prayerful people and a prayer-formed medicine” who will delight in human flourishing, including the human flourishing we call health.

A Final Note
Having isolated arguments on life issues facing society will never convince our younger Millennial generation to focus on life over death. It is only when we engage their faith and open them to a new Ars Moriendi will causes that advance the culture of death, such as physician-assisted suicide, lose their appeal. Opening Millennials to live the faith in Christ gives them the tools they will need to travel a path through life and a path through death to eternal life.

Editor’s note: Pictured above is a detail from “Death of the Virgin” painted by a master of Amsterdam, ca. 1500.

Gregory Webster

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Gregory Webster is a permanent deacon of the Archdiocese of Chicago. He has a Ph.D. in Analytical Chemistry from Northern Illinois University, a MBA from Keller Graduate School of Management and a M.A. in Theology from Holy Apostles College and Seminary. When not at his day job as a research chemist in a major pharmaceutical industry, he is continuing his studies at Loyola University of Chicago’s Neiswanger Institute for Bioethics.

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