Living Well and Dying Faithfully: Christian Practices for End-of-Life Care (review)

This book emerged from a three-day meeting of interdisciplinary "expert scholars." Together they explore the role of Christian practices in end-of-life care (x), with the intent to reframe the relationship between medicine and theology, choosing to "do medicine in a theological context rather than doing theology in a medical context" (xviii). While contemporary Western culture gives priority to medical and funeral practitioners as the "experts" on death, these authors argue that the process of dying is a deeply meaningful and spiritual human experience that includes the search for God, meaning, hope, purpose, forgiveness, and even salvation. Hence these themes should be seen as central to the tasks of end-of life care (xviii). This is a laudable goal in a death- and grief-denying culture, fearful of suffering.

An underlying premise woven into the book is that end-of-life care is grounded in how we live life now, long before we approach our own death, including necessarily life-long spiritual practices of the individual Christian within community. Unlike other literature in this area, the first chapter describes the importance of the contemplative practice of "Practicing the Presence of God." This foundational focus is useful in a text suitable for theological students, clergy, and others seeking to offer care to the dying. Suffering, which in a medical context is problematic, at best avoided, at worst diagnosed and treatment-focused, is unpacked from a theological perspective. The authors bring resources of the tradition such as lament, prayer, sacraments, and the importance of truth-telling to what is often a difficult issue. Prophetic practices of care, that include advocacy as well as personal and communal narratives of resistance, challenge the predominant cultural narratives that deny human finitude and death (54, quoting Scheib in Challenging Invisibility, 128).

The life and death of Joseph Cardinal Bernardin is offered as a high standard of "dying faithfully" (chap. 4). Engaging biblical attitudes toward death, historical, theological, and experiential wisdom, the authors argue that when Christian practices are healthy, dying well embraces both lament and hope, as well as a sense of divine judgment and mercy. Lament, an ancient practice that acknowledges the despair and anger evoked by death, is seen as integral to Christian practice (21). The book includes an excellent practical articulation of how modern medicine employs the "language of restoration" to avoid the painful and difficult real conversations of suffering and dying. Titled "The Wrongheadedness of 'Glorious Medicine"' (121), this practice deprives patients and families of doing necessary end-of-life work such as healing of relationships, forgiveness of self and others, and preparing for death.

A theology of the cross is given as a starting place for the practical and theological insights into the nature and goals of end-of-life care (chap. 6). The authors reiterate the "treasured promise" of Romans 8:38-39 that death does not separate us from the love of God or those we love on earth (22). With an understanding that healing is more than cure and that the patient participates in spiritual and emotional healing in the midst of dying, specific examples are offered of how pastors and chaplains can bring the wisdom of the Christian tradition to the bedside, using tools of spiritual assessment and care. This, they argue, rather than offering more treatment when it is no longer effective, brings dignity and hope (chaps. 8, 10, and 11).

The target audience is Christians of Euro-American descent, primarily of mainline theological traditions. While the book argues for the primacy of Christian theological and spiritual themes over contemporary medical practice in very useful ways, it makes little attempt to broaden the language so that these themes become more accessible to those outside of Christianity. It also fails to challenge classical fall-redemption theology with feminist hermeneutics, or insights based on Creation-centered or evolutionary Christian theologies. Such reflection would be...