Death aversion and the spiritual identity of palliative care

Disclaimer: palliative care as a multidisciplinary clinical “approach” to serious illness is not identified with any particular religious tradition. Palliative care does, however, have an essential spiritual component that distinguishes it from other medical specialties. What follows is a meditation on the spiritual identity of palliative care from snippets of both the Christian and Buddhist traditions.

tibetan-sky-burial-1

Where the corpse is, there the vultures will gather.” Luke 17:37

The roots of death averse culture lie in preoccupation with the self and the life of the body. Modern physicians and patients seek to preserve life at any cost, preferring to ignore the gospel teaching that “whoever seeks to preserve his life will lose it.,” which precedes the pronouncement about vultures. The medical profession’s business, its very identity, depends on its ability to preserve life above all else, rather than to “lose” it. Doctors and patients alike consider it a failure to lose what they conceive of as a battle with cancer.

But wait, doesn’t Jesus himself bring people back to life and restore seriously ill people to health? He is even known as the “divine physician.” So what’s up with not “preserving” life and using corpses and vultures as teaching props?

Jesus heals and brings people back to life out of compassion for their suffering and to manifest God’s power, not because he believes the life of the body to be of supreme importance. His teaching that we will “lose our lives” when we try to preserve them points to how we cause suffering by fixating on the life of the body and fearing death (the corpse), rather than nourishing the life of the spirit. Jesus is pointing his followers to the the spiritual poverty of mistaken identity, warning those who identify primarily with the body, that they will lose their lives. They won’t just lose their bodies by dying physically, they will die inside and suffer spiritual poverty while still embodied.

The Tibetan Buddhist practice of meditating on corpses and vultures, in graveyards, and at “sky burials,” also resonates with this teaching. The explicit aim of Chod practice is to dis-identify with the corporeal body while appreciating the precious opportunity it provides for liberation. The practitioner observes disintegrating corpses, reflecting that his own body will be a corpse one day, ultimately seeing clearly how the body serves simultaneously as a vehicle for liberation and as food for the vultures. Human life, which by definition is mortal, and death’s very inescapability, make committed spiritual practice an urgent priority. Reminding themselves of this, many Buddhists, echoing the 13th century Zen master Dogen Zenji chant

Life and death are of supreme importance.
Time passes swiftly and opportunity is lost.
Let us awaken,
awaken….
Do not squander your life.

Likewise, Jesus points out that excessive preoccupation with self, with the life of the body, makes us miss the connection with the larger life spirit that enfolds it and originally brought it forth. He is saying that this is a great loss, worse than the loss of physical dying.

One reason modern westernised cultures fear the corpse so much is because death and dying are no longer part of ordinary life in countries not experiencing war (or ebola). Before the advent of the medical industrial establishment, which sees death as a failure of its mission, people died at home. Women washed bodies and prepared them for the cemetery at home. Now that dying is hidden inside hospitals and nursing homes, and corpses are whisked away as soon as possible, modern consumers of medical care can put off thinking about what inevitably awaits them. And the medical profession is only too happy to collude in that procrastination, having taken it upon itself to “preserve” life for as long as possible at any cost.

The desire to medicalise and preserve life beyond its natural span has produced a death-denying culture that causes great physical, spiritual, and financial suffering to patients and families. The rapid ageing of our societies, though, added to the movement to bring dying back out of the hospital and back to the home will help to remedy our illiteracy about death. This move to bring dying home must also include clinical, spiritual, and emotional support for caregivers though, since demographic and employment structures have changed since the days when people routinely died at home.

One such support, of course, is palliative care. Palliative care does not seek to “preserve” life at any cost, but offers patients and families sophisticated clinical, spiritual, and psycho-social skills to alleviate the symptoms and sufferings of serious illness. It serves both patients who are not terminal, as well as those who are actively dying. Palliative care thrives on an ethic of accompaniment, which places the dignity and wellbeing of the individual patient and family at the center of the team’s concern. Rather than labouring to preserve the life of the body, spiritual counsellors on palliative care teams support patients and families connection with the life of the spirit, thereby “saving” that life as the other slips away.

Future blogs will focus on how palliative care alleviates spiritual suffering of patients and caregivers.

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Published by

kpettus

I am a political theorist, oblate in the Order of St.Benedict, and advocate for universal rational access to essential controlled medicines for pain and palliative care in the lower and middle income countries. I work a lot in Vienna at the Commission on Narcotic Drugs, and in Geneva at the World Health Organisation, and the Human Rights Council representing the International Association for Hospice and Palliative Care. Right now I am full time caregiver to my sister Ruth, who has brain cancer and lives in Baltimore. I am also writing a Catholic Caregiver's blog to document the experience.

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