DON'T believe everything you see on Holby City. My
experience of working in A&E has been more mundane. The recent
debate over the care of the dying in hospital has avoided the
question of what society considers to be a "good death", and shown
that dying remains the last great taboo.
I hope that the Church can offer much to the debate about how
the end of life is approached in hospitals, how society's fears
about death can be reduced, and how people can be supported as they
plan for the end of life. I have often encountered a gulf between
the expectations of patients and their relatives, who have little
experience of what the end of life can mean, and the reality of
what medicine can offer.
As Westerners tend to die in hospital from chronic illnesses,
the grim reaper has become hidden behind closed, clinical doors. I
have found that this great unknown exacerbates the fear of death.
The Christian message that death is part of life, but is not to be
feared because of Christ's resurrection victory needs to be heard
now more than ever.
Western society is changing its concept of what healing means.
As medicine advances and people get older, illness is not cured;
rather, symptoms are "managed" through a combination of drugs and
therapies. This results in a complex web of co-morbidities which
alter or impair quality of life.
Medicine often sees only the physical aspects of illness. As
Christians, we try to see beyond that to what makes the whole
person tick, to someone who is special in God's eyes; so "doing
everything possible" to keep people alive becomes more than their
tablets and tests.
The Church is often a source of help for those seeking relief
from the massive changes that long-term illness brings. Be it in
hospital or hospice chaplaincy, pastoral teams visiting nursing
homes, or social outreach to the frail, the Church's prayer and
fellowship alongside people in infirmity is a witness to the
continuing importance of spiritual care.
More people in the Church's pastoral networks are trying to
reconcile chronic conditions with their lives as patients and
carers. A phone call, a visit, or an offer of respite for an
exhausted carer are all signs of fellowship. When Christians are
surrounded by a hedonistic culture that offers life at all costs,
we have a duty of witness to people who seek God's healing,
reconciliation, and unconditional love.
IF YOU have ever been involved in giving cardiopulmonary
resuscitation (CPR, or chest compressions and defibrillation), you
will know that it is an undignified, brutal, and messy business. I
will also add distressing and painful to that list. If you have
survived a cardiac arrest, you are extremely lucky: to be alive
without any lasting damage is rare.
Medicine can, in theory, "manage" most chronic conditions -
including dementia, MS, and heart, liver, and lung disease. When
long-term illness deteriorates into an emergency, and when hospital
staff have given every available treatment, CPR is the last
possible hope that the patient will improve. Yet the public
imagination, aided by the dramatic TV portrayals of medical
emergencies, forgets that CPR is not resurrection. You do not get
up and walk away, because the chronic conditions that may have
originally caused the heart to stop beating are not miraculously
Some people hope that deteriorating illness will be instantly
fixed: that CPR will keep death at bay just that bit longer.
Unfortunately, the medical jargon that surrounds CPR compounds
this. All too often, I have been asked: "Did you get him back?"
after a cardiac arrest. The hope is almost of resurrection, of
coming back from the dead.
Thankfully, the pricelessness of allowing someone to embrace the
end of life in peace and comfort, rather than seeing death as a
failure of medicine, has been a great gift from the hospice
movement to acute hospitals. For Christians, life and death are in
God's hands, and so we need to call for the continuing importance
of mercy and grace in clinical medicine.
It is only recently that medicine has been able to ask of
patients with deteriorating medical histories "What are we bringing
them back to?" This must not be an arbitrary decision about
As medicine becomes more invasive and demanding on the lives of
patients and their families, medical staff need to have the
confidence to allow patients to make their own informed choices
about an acceptable quality of life, and how treatment progresses
and ends. The Church can encourage honesty, compassion, and dignity
THE provision of "Do not attempt resuscitation" orders (advance
documents which tell medical staff not to start CPR, after
discussion between the family, patient, and doctors) have become
increasingly prevalent in hospitals and long-term care facilities.
To this I say: alleluia. This is because there are many other ways
of "doing everything possible" for someone who is seriously ill,
through the provision of pain-relief, fluids, antibiotics, and a
caring, peaceful environment.
Patients (young and old) who have been battling chronic illness
may not wish to face death in a haze of blue lights, pain, noise,
or the loneliness of an ambulance trolley. One man described how he
had refused CPR because he wanted to die on his own terms, without
his family having the pain and distress of a final emergency; for
him, this lessened the fear of dying.
When used well, I have found "Do not attempt resuscitation"
orders help staff to begin discussions about people's wishes for
their quality of life, and their preferences for what care is (and
is not) provided. While a national replacement for the Liverpool
Care of the Dying Pathway is sought, there remains a long way to go
in changing attitudes to the end of life, to ensure that patients
receive dignity and compassion alongside life-prolonging care.
We also need to ask how our Church supports those whose lives
are burdened by illness. In a society that often enounters death
only in the media, the Church can offer teaching and experience
from its daily work in how physical and spiritual care come
together in a timely, peaceful, and dignified death. This voice
needs to be heard.