As Loved Ones Die (2)

“Your mother has a very strong constitution.”

The nurse is right.  She does have a strong constitution.  Four days ago they stopped giving her food and liquids.  (Along with a DNR she had insisted, “No tubes, no forced feeding!”)  Since then she has been fitfully asleep or semi-comatose, her emaciated body resting uneasily in the bed.  Despite the extra oxygen, her breathing has become increasingly rasping and intermittent.  Yet she carries on.  The hospice team is careful to maintain what they feel is an adequate amount of morphine and we regularly swab her open mouth with glycerin pads.  When we speak into her ear, there appears at times to be a faint response.  Or is it our imagination?  “We love you, Mother.  You can go on whenever you’re ready.  We’ll be fine.  We just ask you to pray for us, to prepare our way into God’s eternal care.  We’ll join you soon.  We love you; I love you!  Thank you for all you have been for us, all you have done for us, all you are for us….”  It may be that she hears us, that she understands.  Then again, maybe not.  In any case, we continue our vigil: reading psalms, talking together about old times, praying, waiting.

She is in her ninety-second year, and for a long while she has wanted to die, to pass on into the merciful arms of God.  The past few years have been long and tedious.  She broke her hip a good while back, and since then she has been confined to her bed and her easy chair.  As time passed, she wanted less and less to be wheeled outside into the fresh air.  A few months ago her weight loss accelerated so that now she weighs barely over sixty pounds.  For the past couple of years she has become increasingly deaf, yet she detests wearing hearing aids (more than once we have found them wrapped in Kleenex and deposited in the trash basket next to her bed).  She used to read voraciously, but for a long time now her mind has refused to concentrate.  When she could no longer remember characters and story lines, she gave up her favorite pastime, finally staring blankly at the tube, no matter what was on.

Now she is dying.  It’s impossible to say what connectedness she might still have with the world around her, with us who love her.  Deep within, as she declared not long ago, she longs to die.  But for the time being she can’t, because she has a strong constitution.

Sooner or later nearly every family is called upon to make this kind of vigil.  Sooner or later most of us – if we are spared from an accident, a fatal heart attack or some other swift end to our life – will spend our last days in hospital or in hospice, surrounded by friends and family, who will miss us dreadfully yet will want desperately for the waiting to be over and for the grieving to run its course.

It is impossible not to allow ourselves a slew of questions.  Must she suffer until the bitter end?  Is it reasonable, for her or for us, to wait until the body simply gives out, even though the mind has essentially gone?  Is the pain medication in fact adequate?  Then why does she writhe like that?  Does she actually hear us when we speak to her?  Is she “here” in any meaningful sense?  Or has her soul in reality “left her body,” so that what we see wasting away before our eyes is a mere cadaver, a visible shell that no longer harbors life in any spiritually significant way?

The questions provoke a shudder.  Behind them is the unspoken thought of euthanasia, a “mercy killing” that presumes both the right and the obligation to shorten a painful dying process, once begun, and to offer relief and final rest both to the patient and to those who accompany that patient.  On the one hand, some intentional shortening of the terminal agony seems only reasonable, perhaps even morally obligatory.  On the other, we assert as an article of faith that only God, and not the family or medical team, can properly determine the moment and the means of a person’s death.  Nevertheless, we must admit that despite that assertion, Scripture and Tradition are curiously silent on the matter.

Does God truly desire that each of us die of purely “natural causes,” regardless of the degree of suffering the gradual failure of vital organs or the ravages of incurable disease might impose?  Does the Orthodox Christian conviction that every human life is sacred preclude any serious consideration being given to the quality of that life?  If we may not “put someone to death” (to avoid the loaded terms “kill” or “murder”) by the direct intervention that would constitute euthanasia, then is there some viable alternative to such intervention that would enable the dying person to pass on into life beyond (relatively) pain free and in peace?  And can that alternative include a protocol that might allow death to come sooner than it would if we resorted to “medical heroics.”  A protocol that would leave both that person and those who accompany him or her “blameless,” that is, free of guilt, before God, the family and society?

These are the kinds of unspoken questions I and others who are here keeping vigil cannot avoid posing to ourselves as we watch my mother gasp for breath and wither away in the last hours of her earthly life.  Once a terminally ill patient in this condition has finally passed on, then family members and even medical professionals often admit that such questions crossed their minds as they witnessed that patient in the final stages of the dying process.  If opiates are not adequate to alleviate that suffering, then what indeed are our options, short of euthanasia?  How does God want us most appropriately to care for this person we deeply love and whose agony we sorely desire to see come to an end?

I don’t have answers to these questions, except to insist that euthanasia cannot be included among them.  I raise the questions simply to give voice to the many faithful Christians who find themselves confronted with the imminent death of a loved one, and who dare not speak their pain and their perplexity for fear that well-meaning members of their family, parish or circle of friends will condemn them for their apparent lack of faith.  It’s easy enough to insist philosophically that only God (meaning the natural biological process) can determine the time and means of a person’s death.  It is another matter altogether when that person, whom you love and cherish, is in the throes of a protracted and agonizing struggle to achieve liberation from the constraints of the flesh, when her every desire and every longing is to die, and to pass on to the blessedness and peace of life beyond.  Then philosophical abstractions become irrelevant, and we, like the dying person we love, are faced with what is perhaps the worst of spiritual struggles.