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End of Life Issues


The last word belongs to God

By Allen Verhey | Presbyterians Today

Death and dying illustration

Illustration by Pat Hilliard

It’s right there in the Apostles Creed: “I believe in … the resurrection of the body, and the life everlasting.” But everyone knows that in the end we all die. Death, not life, seems to be our destiny.

Christians do not deny the awful reality of death, but we do insist that death is not the last word. The last word belongs to God. The last word is not death but life, not suffering but shalom. These convictions make a difference in the way we approach our own death and the way we care for the dying.

Death’s threats

Death is real — and it is a real evil.

Death threatens to alienate us from our own bodies. We eat, work, play and worship in our flesh. In our bodies we discover something of the wonderful variety of color, shape, sound, scent, texture and taste in God’s creation. We reveal ourselves to others in a gesture or word, in a smile, tear or touch.

Death makes its power felt in sickness or pain, when the body is experienced as “the enemy.” Or in the weakness that robs sick people of the capacity to exercise control of themselves and their world.

To its credit, medicine resists death. But its resistance is sometimes presumptuous, pretending to rescue human beings from their mortality, and sometimes desperate, laboring under the tyranny of survival. Patients are sometimes reduced to their pathology. Death can make its power felt in a hospital and in medicine that is technologically oriented to biological survival.

Death threatens to separate us from our communities. We are communal selves, not isolated individuals. But death threatens separation and abandonment.

Death makes its power felt when the sick or dying are separated from those with whom they share a common life. Or when disease so monopolizes attention that there is no space for reconciliation, forgiveness or fun with the family. Or when the fear of being abandoned is not met by the presence of others who care.

Sickness pushes people to the margins of public life. People who are ill can’t work, shop or attend a ballgame. Society insists that the very sick belong in a hospital, under care of a physician, not in public spaces reserved for strength, efficiency and productivity. In the hospital the sick can be further isolated, when they cannot understand, communicate or share their pain and suffering.

Medicine can sometimes identify the pain, make sense of it and manage it by creating a language for it. But the language may not be one the patient understands. Death makes its power felt, first, when a community abandons the sick to medicine, and then, in a hospital when medicine neglects a patient’s need for a community and a voice.

Death threatens our relationship with God. Death threatens our sense that the One who sustains us is dependable and caring. It threatens separation from God. It threatens our identity as cherished children of God.

Death makes its power felt whenever the sick and dying, or those who care for them, are not assured of the presence of a God who cares. Death without a loving God signals the unraveling of meaning and the destruction of relationships.

Resurrection hope

In the face of death and its power, Christians have hope. Christian hope is not just wishful thinking. The grounds for hope are found in Scripture and in the faithfulness of the triune God.

The Bible story begins with creation, when God’s breath made the dust “a living being” (Genesis 2:7). From the beginning it was clear that without God, humankind would make its inevitable way toward death.

Christian hope is not grounded in a “soul” that has its immortality independently of God and finds liberation in the death of the body. Neither is it located in some romantic account of the cycles of nature always bringing the return of life and spring. And hope is not to be found in the technological mastery of nature through medical science.

Our grounds for hope rest in the powerful and creative word of God, which can call a cosmos out of chaos, giving light to the darkness and life to the dust.

The biblical narrative continues with the story of human sin and of a “curse” that rests on the whole creation. Even so, there are grounds for hope in God’s faithfulness and refusal to let sin and death have the last word.

At the center of the Christian story is Jesus of Nazareth, who came announcing the good future of God. He demonstrated the power of God’s good future in works of healing and words of blessing.

As we say in the Apostles’ Creed, Jesus “suffered under Pontius Pilate, was crucified, dead and buried.” His death was real and horrible. He wept at the prospect of alienation from his flesh, from his friends, and from God (Mark 14:33–34; Hebrews 5:7).

But God raised Jesus from the dead, “the first fruits of those who have died” (1 Corinthians 15:20). By raising Jesus up, God established once and for all the good future, the destiny, of which Jesus spoke.

Because Jesus has been raised, the Holy Spirit has been poured out. As Paul says, “the Spirit helps us in our weakness” (Romans 8:26). The Spirit is at work when the sick are healed, when the grieving are comforted and when (as at Pentecost) people understand each other. The Spirit is at work in the church in practices that meet the threats of death with faithful care for dying persons, and with confidence that nothing can separate us from the love of God.

Facing death and suffering

With courage

Throughout Scripture life and its flourishing are celebrated as good. Even so, our earthly survival and ease are not the ultimate goods.

Jesus Christ walked steadily and courageously the path that led to his suffering and death. Christians are called to follow him on a path of heroic discipleship, to take up his cross (Mark 8:34). Sometimes life must be risked and suffering endured for the sake of God’s cause in the world. Death and suffering need not be feared, for they are not as strong as the promise of God.

Martyrs for the faith have drawn courage from the conviction that not even death could separate them from God. In less dramatic ways, Christians suffering from life-threatening illnesses bear witness to their hope by their readiness to die but not to kill. This may mean refusing offers of assisted suicide. It may also mean declining treatment that would prolong their days, but only by rendering them incapable of using those days (or months or years) for reconciliation with enemies or fellowship with friends or simply fun with the family.

With patience

Patience is not to be confused with stoic resignation. The stoic ceases to fear by ceasing to hope and care. The Stoic philosophers of ancient Greece had no place for (and little patience with) lament; they did make a place for suicide, for quitting life.

In contrast, the New Testament book of Revelation invited the churches of Asia Minor to patient endurance. Such patience does not curse God or choose death, but endures both death and dying with hope. It knows that sickness and suffering signal not just the power of death and chaos, but also our human limits and our dependence upon God. With patience and courage the Christian can “let herself go” toward the good future of God.

With lament and joy

Jesus blesses “those who mourn” (Matthew 5:4) — the aching visionaries who long for God’s future and who weep because it is not yet. Christians are called both to rejoice and to grieve “in hope” (Romans 12:12; 1 Thessalonians 4:13).

A lament is not a dirge. A dirge moves from glory to shame, from strength to powerlessness. The decisive feature of a dirge is this contrast between past glories and present misery: “How are the mighty fallen!” (2 Samuel 1:19–27). The suffering find a voice — but not hope.

A lament is addressed to God. Its confidence in God’s faithfulness reverses the tragic ending of the dirge. The Psalms of Lament move from invocation to complaint to prayer for help, and finally to the certainty of a hearing. Lament gives the suffering voice, and allows the sufferer to hold on to God’s promise that tragedy is not the last word.

When congregations leave aside the language of lament, those who suffer think they sit alone. By retrieving the language of lament, we renew our capacity for compassion and grow more attentive to the voices of those who suffer. But Christians also celebrate with joy whenever God’s good future makes its power felt in this sad world.

With compassionate care

Jesus’ parable about the last judgment (Matthew 25:31–46) testifies to the importance of compassionate care. We may join those in the parable sputtering, “Do you mean to say that was you, Jesus? That old man suffering his way to death was you, Lord? That nauseating woman was you? Do you really mean that broken body was your spiritual presence?” And the answer is always “yes.”

Death, as noted earlier, threatens alienation from our bodies. A caring community meets that threat by relieving pain and nurturing the strength of patients to exercise self-control and responsibility. We care for patients by giving attention to the music, flowers and foods they enjoy, and by the human touch that signals compassion.

We meet the threat of alienation from community by visiting the sick and dying. We help patients recover their voices, even if only in lament. We practice hospitality to patients and their visitors, making them comfortable and welcome.

We meet the threat of alienation from God, but not by trying to dispense God in pleasant little doses, like so many aspirin. We keep faith with the sick and dying as a sign of the divine love that is always present and as a signal of the hope that is already real.

The church can help doctors and nurses understand their work as a holy calling, as a form of discipleship of the suffering and saving Christ. We may signal together that death is not the last word.

“I believe in … the resurrection of the dead, and the life everlasting.” May the words of the creed shape our dying and our care for the dying.

Allen Verhey is a professor of ethics at Duke Divinity School. He acknowledges his indebtedness to an essay by William F. May, “The Sacral Power of Death in Contemporary Experience,” in On Moral Medicine: Theological Perspectives in Medical Ethnics (Eerdmans, 1987), which he co-edited with Stephen Lammers.

This article originally appeared in the May 2008 issue of Presbyterians Today.