Norfolk science-faith lecture on 'dying well'
It is often said that the prospect of death concentrates the mind wonderfully. This has been sadly and widely illustrated during the coronavirus pandemic, and the June meeting of Science and Faith in Norfolk focused on the medical practice of palliative care in this context.
Report by Patrick Richmond and Nick Brewin
Click here to see a recording of the talk
The speaker was John Wyatt, Emeritus Professor at University College London with a special interest in medical ethics. The online audience included a wide range of healthcare professionals, chaplains and many people with direct personal experience of caring for the sick and elderly.
The speaker began with two illustrations of what, in his opinion, is involved in “dying badly”. The first example relates to an intensive care unit for Covid-19. For the bewildered patient, the only human contact is with an unrecognisable doctor or nurse, completely masked in personal protective equipment. Tragically, the patient is denied any engagement with family or friends at their bedside. Professor Wyatt used this scenario to warn against the use of medical technology in ways that are not necessarily in the best interests of the patient. Alan Verhey, a modern theologian, described the situation in the following way: “The body of a dying person has become the battlefield where heroic doctors and nurses wage their ceaseless war against death”. There is an obvious risk that the well-being of the patient may be lost in the fog of medical warfare. For some people, their greatest fears are of medical over-treatment and of excessive and burdensome intervention.
Professor Wyatt’s second example of “dying badly” related to euthanasia and assisted suicide, which is coming back into public discussion. He argued that the language surrounding what is now euphemistically called “assisted dying” has been deliberately softened and sanitised to conceal its implications for the individual, their friends and relatives and for medical ethics and society in general. The harsh reality is that the procedure involves “medical killing.” Legal restrictions preventing euthanasia of patients with dementia and children under 12 in various countries are being removed and in Ontario, Canada, euthanasia patients are an increasing source of organ donations.
The speaker then went on to explain what he meant by “dying well”. Before the advent of modern medicine, the most common ideal was for someone to have “died peacefully at home”, being supported by family, friends, doctors, nurses, priests and whatever. As an early example, he quoted from an influential Christian document “Ars Moriendi” – the Art of Dying. This dates back to the early 15th century – the period when the Black Death was sweeping through Europe. It offers guidance on the five spiritual temptations that often beset a dying person. These are listed as doubt, despair, anger, pride and greed.
To these, Professor Wyatt added two modern temptations: denying the inevitability of death and the temptation towards self-reliance rather than mutual interdependence. He emphasised that vulnerability and dependence are not alien, undignified aspects of humanity – they are a standard part of the story of every human life. From a Christian perspective, there comes a point when death changes from an enemy to be resisted into a gateway to a new existence. With these ethical thoughts in mind, modern medicine must recognise its limits. In the quest to prolong life we must know when to say, “enough is enough”.
During end-of-life care, there is a critical need to balance the benefits and the burdens of medical treatment. Cicely Saunders was one of the first people to articulate the emerging ethos of palliative care, which intends neither to hasten nor impede death but to maximise the quality of care: “Not only will we help you to die well, we will help you to live before you die”. “You don’t have to kill the patient in order to kill the pain.” Palliative care is distinct from many forms of modern medicine in that it tries to take a holistic approach to the alleviation of all forms of pain – physical; psychological; relational; and spiritual or existential pain. John Wyatt argued that end-of-life care should be seen as a joint responsibility involving medical professionals, family and friends. Together, they should seek an opportunity for dying well by providing a time and space to focus on the things which really matter to the patient.
After the talk there were questions and discussion in small groups. Professor Wyatt explained that suicide was often seen as an honourable way out in the pre-Christian classical world but in Christianity it is normally seen as a symptom of hopelessness and despair. Christian self-sacrifice does not involve the intention to kill oneself. He feared that allowing assisted suicide and organ donation will increase the moral and social pressure on vulnerable people to choose to die. Palliative care had originally been developed in the context of caring for cancer patients, but there is now a need for expert end-of-life care more generally.
Regrettably, palliative care is not afforded the status and financial support that it should receive within the NHS or within society at large. Far more attention is given to new life-saving treatments and the impression created by dramas like Holby City may be that resuscitation is far more successful than it really is. Professor Wyatt closed his talk by urging that the public, and in particular the faith communities, should campaign to raise awareness of the importance of end-of-life care. The topic is an awkward one because most people are reluctant to talk about death and dying, either from a medical or from a personal perspective, but sooner or later, it will affect us all.
For those, interested in pursuing themes on medical ethics, John Wyatt has written several books including “Dying Well” (2018); “Right to Die” (2015); and “Matters of Life and Death” (2009). A new book “The Robot Will See You Now”, on Christian responses to the challenges of Artificial Intelligence, will be published in July 2021.
The meeting was organised by Science and Faith in Norfolk (SFN), a Norwich-based group which aims to explore the broad interface between science and religious belief. For further information, Contact Dr Nick Brewin (07901 884114); firstname.lastname@example.org . Visit the SFN Homepage or follow SFN on Facebook.
A recording of the talk is now available on the Facebook page of Science and Faith in Norfolk with the following link https://fb.watch/5-7Z5VBcPD/
Photo of Prof John Wyatt courtesy of Norwich Cathedral by Bill Smith