We talk about costly final hospital stays, about living wills, about Dr. Jack Kevorkian. We talk a lot, it seems, about death. Now a book of essays, "Facing Death: Where Culture, Religion, and Medicine Meet," encourages us to consider -- and start talking about -- much more than what's in the ledgers, forms and headlines.
Many of the essays are by physicians, who tell what they have learned from dying patients and their families. Others are by historians, philosophers and theologians, who describe how some cultures have dealt with death and how religions have provided a framework for understanding. The book, being published this month by Yale University Press, was edited by Drs. Howard M. Spiro and Mary G. McCrea Curnen, both on the School of Medicine faculty, and byLee Palmer Wandel, who teaches history and religious studies at Yale.
"We need to open our eyes to what we do, and our hearts and minds to what we fear," says Dr. Spiro, a gastroenterologist who directs the medical school's Program for Humanities in Medicine. He notes that physicians are trained to wage high-tech war against disease, tend to view death as defeat and are often not prepared to deal with emotional and spiritual needs -- either their patients' or their own. Meanwhile, patients and their families -- that includes all of us, at sometime or other -- may have terrible fears or unrealistic hopes.
"We hope the book will open up discussion of the dying process and the meaning of death, in a non-scientific, humanistic way," says Dr. Spiro. The aim is to help everyone -- including physicians -- view death less as an adversary, and more as a defining part of life."
In "Facing Death," Dr. Sherwin B. Nuland, a clinical professor at the medical school and author of the best-selling book "How We Die," stresses that even when there is no hope of cure, physicians can -- and must -- give their dying patients the hope that they will not suffer unnecessarily, that they will not die alone and that they will "live on in the minds of those they have loved." Dr. Eric L. Krakauer of Harvard Medical School draws on his background in philosophy, and his painful experiences as a young medical resident, as he describes how doctors can offer compassion and understanding to their "most vulnerable and needy patients," the dying. Dr. Alan B. Astrow, an oncologist from St. Vincent's Hospital and Medical Center of New York, speaks against doctor-assisted suicide -- and speaks for the ways physicians can relieve pain and eschew inappropriate technology.
A Yale pediatric oncologist, Dr. Diane M. Komp, tells of learning to listen to children dying of cancer. The director of the Yale AIDS clinic, Dr. Peter A. Selwyn, says that only by acknowledging their own fear of death, and their unexpressed grief, can physicians overcome "pity, despair, revulsion and numbing detachment." A Yale pediatrician and chaplain, Dr. Alan C. Mermann, describes how medical students can learn to help dying patients. Dr. Joanne Lynn of the George Washington University Medical Center in Washington, D.C. calls for fundamental reforms in our health-care system, to better care for the dying. "Now," she says, "it's easier to get open heart surgery than Meals on Wheels."
Contributors from the humanities offer perspective and guidance in this new book, which embraces cultural, religious and medical aspects of death. Some describe earlier times, when people expected to die at home, with family and friends by their side. A cultural historian, William J. Bouwsma of the University of California at Berkeley, notes that our culture, which for so long made death a taboo topic, "is changing for the better -- however gradually -- in dealing with death." A social historian, Arthur E. Imhof at the Free University of Berlin, offers an ars moriendi, or "art of dying," for our own time, when medical science has lengthened our life spans: "Let us transform every one of the years gained into fulfilled ones, and then let us die a peaceful death," he says.