Organic bodies are made to break down. All that it is to be human, emotionally, intellectually, psychologically, spiritually, is bound to the inherent processes of organic life. Creation, preservation, and destruction together form the triad which sciences and religions alike recognize as the most elementary meaning of what it is to be alive. Yet the approach to medicine and health care in our present age fails to sufficiently grapple with the fundamental realities which spring from living that meaning all the way to the end. Medical professionals know, more than ever, how to help people live. Our era is desperately asking: is it also their responsibility to know how to help people die?
Allopathic medicine is concerned with preservation of the body: how to sustain functions according to standardized measures of normality for the greatest duration. For people still in early to mid-life phases, this generally aligns very effectively with both the patient’s and physician’s aims. But for people nearing or in the end-of-life phase, other concerns arise. Primary among these is a concern with quality of life as separate from quality of the body. While M.D.’s are expertly trained to assess and aid in decision-making related to the former, they receive little to no formal training in the latter. In the interim, a host of other medical professionals and caregivers lean in, including nurses, psychologists, child life specialists in pediatric circumstances, family members, community organizations, and social workers. But even in the best of circumstances, formal training is often lacking and, indeed, what would appropriate formal training constitute?
Predominantly throughout history, the guides for end-of-life decision-making and care have been members of the individual's spiritual or religious community. Depending on the culture and era, medical practice itself was considered inseparable from the very mystery of existence. Over time, the education of medical professionals has steadily shied away from the unknown and toward a clutching grasp on the known alone. So, although many hospitals and medical facilities still retain a position for someone from a religious community, their role is often confined to consolation with what is rather than participation in decisions impacting what end-of-life. And just as the medical professionals a person encounters in a hospital setting are predominantly strangers, so the person in this role is likewise a stranger. Can we leave it to strangers to guide us through the end-of-life phase and dying process?
The question of dying well butts against so much that institutionalized allopathic medicine has grown to embody. It requires a diminishing importance on preservation of the body. It requires increased understanding of the natural processes associated with end-of-life and dying. It requires a network of meaningful relationships. It requires embracing the unknown. It requires including death as a part of life. We cannot ask for, locate, or lean on these values in others until we cultivate them in ourselves. The question of redesigning end-of-life experience suddenly blooms into the question of redesigning how we live, what we value, and who we are.