Death Is Not the Enemy

DEATH IS NOT THE ENEMY RICHARD L. LANDAU1 and JAMES M. GUSTAFSON2 Karl Barth, a 20th-century Protestant theologian, wrote, "Life is no second God, and therefore the respect due it cannot rival the reverence owed to God." On the other hand, for secularized persons in a secular society, there is no "first God" and thus nothing due more respect or reverence than life itself. Life and its preservation become more than the necessary conditions for the realization ofa measure ofself-fulfillment and for capacities to contribute to other persons and to society. They become virtually ends in themselves. The pursuit of health and the preservation of physical life seem to have replaced "salvation," the glorification of God, or the beatific vision as the chief end of man. To the secular person, what theologians call "the conditions of finitude," those inexorable restraints and limitations on human life of which the final one is death, seem repressive since there is nothing real or lasting beyond them. A kind of physical fundamentalism comes into being; the practical dogma is to preserve life as long as medically and technically possible. If God is functionally designed as one's "ultimate concern" (to use a term of another Protestant theologian, Paul Tillich), the preservation oflife becomes one's God. If one's ultimate object of trust is fundamentally one's God, life becomes one's God—or one's idol. We are not concerned to argue for the existence of God, or for some form oflife after death. We do not claim that a religious outlook is necessary to avoid absolutizing the value of physical life. Secular persons can consent to the conditions of finitude, to the reality of death, to conceiving of death as sometimes friend as well as enemy at least as readily as the religious person. We are concerned, however, to reflect on some of the outcomes of the preoccupation with the preservation of physical life. The intensification of concern to sustain and presene life is the other side of concern to avoid physical death. These concerns may have obvious benefits in most Department of Medicine1 and The Divini« School,2 The University of Chicago, 1025 East 57th Street, Chicago, IL 60637 Reprinted from JAMA Vol. 252, page 2458.© 1984, American Medical Association. 0031-5982/97/4004-2030$01.00 150 Richard L. Landau andfames Al Guslafson ¦ Death Is Not the Enemy circumstances—the prevention of many risks through public health measures and educational activities directed toward preventive medicine and personal hygiene and the development of therapies for countless diseases. An intense preoccupation with the preservation ofphysical life, however, seems sometimes to be based on an assumption that death is unnatural, or that its delay, even briefly, through medical and technical means is always a triumph of human achievement over the limitations of nature. It is as if death is in every case an evil, a kind of demonic power to be overcome by the forces of life, propped up by elaborate medical technologies. Dramatic medical interventions portrayed in the media become living "westerns." The powers of death are the bad guys, to be vanquished by the good guys, dressed in white coats, rather than white hats. Every delay of death is a victory by the forces of good. Or, to change the analogy, the development and use of costly and dramatic end-stage therapies are seen as the "arms" to be used in a "crusade," a war fought over "holy places" because they were occupied by an alien, and therefore enemy, power. A "crusading mentality " comes into being; almost any means is justified when it will delay the enemy, death. We do not wish our position to be construed as being obstructive to scientific and technologic research, but we do believe medical scientists should be reminded that death is as integral an aspect of human life as it is of all other biologic species. The development of technologies with the prime aim of prolonging life should be seriously questioned if the ultimate result is destined to be a grotesque, fragmented, or inordinately expensive existence . We were not privy to the discussions of the institutional review board at the University of Utah...