Facing the reality of death

That most beloved Lebanese poet Khalil Gibran wrote in The Prophet:

For what is it to die but to stand naked in the wind and to melt into the sun? And what is it to cease breathing but to free the breath from its restless tides, that it may rise and expand and seek God unencumbered? Only when you drink from the river of silence shall you indeed sing. And when you have reached the mountain top, then you shall begin to climb. And when the earth shall claim your limbs, then shall you truly dance.

Maybe it is time to look death in the face and not be afraid. Death is not something we inevitably face, but rather an event that we prepare for day by day, each time we let go of the little things in life. Death is a daily process – physiologically, psychologically, and spiritually. What tempers the loss is the fact that we believe all this leads to our final union with God. Christian existence finds its meaning in Christ:

Listen, I will tell you a mystery! We will not all die, but we will all be changed, in a moment, in the twinkling of an eye, at the last trumpet. For the trumpet will sound, and the dead will be raised imperishable, and we will be changed. For this perishable body must put on imperishability, and this mortal body must put on immortality. When this perishable body puts on imperishability, and this mortal body puts on immortality, then the saying that is written will be fulfilled: ‘Death has been swallowed up in victory.’ ‘Where, O death, is your victory? Where, O death, is your sting?’ (1 Cor 15:51-55)

 Or as Ram Dass beautifully puts it, ‘When all is said and done, we’re really just all walking each other home.’

Jesus was familiar with the fact of dying and confronted it time and time again. He raised the widow’s son at Nain (Lk 7:11-17), restores Lazarus (Jn 11:1-44) and a twelve year old girl to life (Mt 9:18-26), and grieved over the death of John the Baptist (Mk 6:14-29). Jesus faced his own anxieties as well. Jesus takes his disciples to Gethsemane. It is the place all who are dying must pass through – a place of struggle, loneliness and fear. Yet also a place to pray, to find strength, to come to an acceptance.

In the Garden, Jesus is ‘deeply grieved, even to death; remain here, and keep awake’ (Mk 14:34). In dying, one needs others there, to be with them, keeping all harm away, someone there to be a presence and a friend. The lesson for each person, is to learn how to listen to the words of grief, to be attentive to their distress and respond with empathy.

Death can be the final chance to become more fully human not only for the one dying but for those at their bedside. Dietrich Bonhoeffer beautifully writes:

Why are we so afraid when we think about death? … Death is only dreadful for those who live in dread and fear of it. Death is not wild and terrible, if only we can be still and hold fast to God’s Word. Death is not bitter, if we have not become bitter ourselves. Death is grace, the greatest gift of grace that God gives to people who believe in him. Death is mild, death is sweet and gentle; it beckons to us with heavenly power, if only we realize that it is the gateway to our homeland, the tabernacle of joy, the everlasting kingdom of peace. How do we know that dying is so dreadful? Who knows whether, in our human fear and anguish we are only shivering and shuddering at the most glorious, heavenly, blessed event in the world?[1]

People want to work hard and die a natural death. To die the way they live. Five stages of grieving/dying were formulated by Dr Elizabeth Kubler-Ross in her 1969 book, On Death and Dying. They are responses to loss that many people have. The stages include:

Shock the reaction that forms out of a feeling of disbelief, leaving a feeling of being temporarily numb. Shock can last from a few days to a few weeks, depending on the gravity of the loss.

Stage 1: Denial – gives people time until they are ready to tackle with the necessary changes.

Stage 2: Anger – a result of feeling loss of control in one’s life.

Stage 3: Bargaining – buying time one hopes to gain control.

Stage 4: Depression – the person experiences sadness but tries to come to terms with the anticipated loss.

Stage 5: Acceptance – when the reality of death is accepted, one becomes ready to die. Elderly generally move to this acceptance largely on their own, while others may need assistance.

In response to the news of impending death people also may exhibit spiritual distress which include continued sense of despair, searching or restlessness of spirit. Questioning occurs and there are regrets for not having lived a life true to oneself.

Palliative or hospice care, is holistic care, involving physicians, nurses, social workers, chaplains and volunteers. It offers one the opportunity to die with love and care, surrounded by family. Hospice care can be delivered in private homes, nursing homes and on rare occasions hospitals.

The gathered people around a dying person, reminds them of their meaningful relationships. The days and moments before death should be a time of reconciliation and release from past hurts. It is a time for being present and placing the loved one in the hands of Christ. So during the last days before death pastoral care frequently takes the form of:

  • Sitting with a family
  • Moistening lips, washing and combing a person’s hair, keeping patients clean and the space around them tidy, to restore a sense of dignity
  • Providing opportunity for last words and goodbye to loved ones
  • Reconciliation
  • Gently urging the family to let go and allow their dear one to die
  • Prayer brings closure and is an invitation to separate themselves from the place of death

The ethical issue of life support

An issue that may arise in caring for the terminally ill is the possibility of euthanasia or when a patient seeks no longer to continue life. The Australian Code of Ethical Standards states:

It is never permissible to end a person’s life (whether that decision is made to relieve a patient’s suffering by euthanasia, to comply with the wishes of the family, to assist suicide, or to vacate a bed). By euthanasia is meant any action or omission which of itself and by intention causes death with the purpose of eliminating all suffering. Examples of euthanasia include administering deliberate overdoses of otherwise appropriate medications, and the unjustified withholding or withdrawing life sustaining forms of care.[2]

Lucy Kalanithi explains that patients have a choice when it comes to medical treatment:[3]

  • Would you want to be on life support if it offered any chance of longer life?
  • Are you most worried about the quality of that time, rather than quantity?
  • Do you want to do dialysis in a clinic or at home?
  • What medical care will help you live the way you want to?

One always has a choice, and it is OK to say no to a treatment that’s not right for the person.

Most wish for their loved one a peaceful and dignified death, yet many worry that their decision to terminate life support might make them instrumental in that death. Doctors often see the stark reality of a situation whereas patients and family are always looking for a miracle, or consider all possibilities before giving up, because pulling the tubes feels like murder. In all cases there is a reluctance to let go.

Dr Stephen Parnis wrote in The Australian, stating that it’s about caring for the most vulnerable and not about supporting assisted suicide:[4]

The relationship between patient and doctor is based on trust. Patients trust that I will always use my expertise in their best interests. Legalising assisted suicide will fundamentally — and forevermore — breach that trust.

. . . Surely, as a community, we should ask how we can alleviate that suffering, how we can address our society’s widespread anxiety about death and dying, how to make quality palliative care truly accessible to all, before reaching for the convenient alternative of an assisted exit.

Patients and families have the right to express their views based on their religious, cultural or familial influence. This matters and determines the choices one makes in regards to prolonging life or terminating. For Catholics the belief is human dignity is expressed in both vulnerable and good times.

Discontinuing life support is not euthanasia because it does not introduce a new cause of death according to ethicists. Medical professionals use four criteria to determine the legitimacy of discontinuing mechanical life support:

  1. The presence of a fatal condition – If the patient stands a good chance of recovery, life support should by all means be used.
  2. The autonomy of the patient – If the patient is conscious, able to communicate, and capable of rational decision making, their desires are paramount.
  3. Whether the therapy is effective – Doctors may withhold or discontinue treatments that are deemed to be futile, ie the patient suffers a terminal condition and death is imminent.
  4. If a medical treatment places an excessive burden on the patient, family or community.[5]

Christians are expected to use all ordinary means to care for the sick and suffering, such as appropriate feeding, hydration, treatment of infection, care and hygiene. The Catholic Church permits forgoing extraordinary care such as discontinuing medical procedures that are dangerous or permanent need for life sustaining machinery.

By Sr Margaret Ghosn


[1] Eric Metaxas, Bonhoeffer. Pastor, Martyr, Prophet, Spy. A Righteous gentile vs. the third reich, (Nashville: Thomas Nelson, 2010), 531.

[2] Code of Ethical Standards, 5.20.

[3] Lucy Kalanithi: What makes life worth living in the face of death | TED Talk | TED.com

https://www.ted.com/talks/lucy_kalanithi_what_makes_life_worth_living_in_the_face_of_death/transcript?language=en#t-557735

[4] Dr Stephen Parnis, ‘Palliative care the answer,’ in The Australian July 26th 2017

http://www.theaustralian.com.au/opinion/palliative-care-system-being-starved-of-oxygen/news-story/ca1b4c9b006a3e22e994161d98662ee5

[5] Noreen Herzfeld, Technology and Religion. Remaining human in a co-created world, (West Conshohocken, PA: Templeton Press, 2009), 50-52.