The Troubled Dream of Life: In Search of a Peaceful Death

Chapter 2. Stripping Death Bare: The Recovery of Nature

Chapter 2 STRIPPING DEATH BARE; THE RECOVERY OF NATURE Death has two powerful imaginative roles. It reminds us in the most unmistakable terms that our individual lives will encounter sooner or later a fixed boundary that, whatever our hopes and dreams might be, death will have the last word. Death also reminds us, as members of families and societies, of the passing of the generations, of the bite of social time. Time means that as children we will grow into the adults who manage the world, start families, and make and love friends. That same time moves us into old age, out of power, watching our children come into the strength and place in the world that were once ours. However varied the narratives of human lives, they must all encompass death. All personal stories come to an end. Old families give way to new families. That has been the way of nature. The ambition of modern medicine has been to do something about that seemingly unalterable fact. It has declared war on death, on the ravages of time, and most of all on the nature that brings them about. It has sought through research to combat the causes of death and constantly to redefine the idea of a premature death. Where a lethal nature once held sway, roughly and uni- 58 THE TROUBLED DREAM OF LIFE laterally asserting its force, technological artifact has been brought in to take its place. Medicine has worked to bring nature to heel, to exploit nature itself cleverly to overcome the limits that it seemed to set on our biological lives. That project has, in its general outline, been a success. Life has been lengthened and death increasinglypushed into old age. People live who would once have died. Yet medicine has failed at one critical point, that of managing the passage between life and death. It does not know, in any reliable technical or emotional way, how to enhance the possibilityof a reasonably peaceful death. Part of this failure is inevitable; there will always be some anguish and uncertainty about the coming of death. But more important is the fact that modern medicine has yet to develop a coherent and integrated understanding of the place of death as part of its effort to remake the human biological condition . In its press to master mortality, medicine has come to distort its understanding of nature, a distortion aided and abetted by public expectations, nicely feeding medicine's own confusions . That distortion can be simply stated: medicine has come, in its working research, and often clinical agenda, to look upon death as a correctable biological deficiency. This stance has thus introduced into the practice of medicine and public attitudes a profound and often destructive self-contradiction. We have been left fundamentallyuncertain whether death is to be accepted as part of life or rejected as a repairable accident. Medicine has further compounded the confusion by conflating human action and the independent actions of nature, imputing to human beings an all-encompassing responsibility for death. We know neither whether death as a biological reality ought to be accepted or rejected nor where, in choosing to struggleagainst death, we should assign responsibility for death when it does occur. We have thereby created a terrible muddle, combining mistakes in self-perception with profound errors about the relationship of medicine and nature. I want in this chapter to explore the latter and try to make plausiblecontentions that mightseem, at first blush, exceedingly strange. Stripping Death Bare: The Recovery of Nature 59 How Medicine Lost Its Way with Nature In its modern struggle to combat illness and death, medicine came to confuse its power to alter, control, or eliminate disease with its power to banish mortality. At the same time, it has managed to blur the dividing line between human powers and the powers of nature. Before I take on those errors directly, it is necessary to understand how medicine lost its way in understanding nature. In presenting my account, I want to make something clear. When I speak of what "medicine" did, I do so as a shorthand way of referring to the values and ideologies that have historically informed the thinking and practices of the people in medicine, and in this case in the medical sciences in particular. Medicine, that is, does not act independently of the people who practice it. I want to stress, however, that my analysis...