Stephen Doran, M.D., is a board-certified neurosurgeon with over 25 years of experience. He is also the author of “To Die Well: A Catholic Neurosurgeon’s Guide to the End of Life,” published this month by Ignatius Press. Stephen also happens to be an ordained permanent deacon for the Catholic Church and serves as the bioethicist for the Archdiocese of Omaha. His writings in bioethics, neurosurgery and gene therapy for brain disorders have been widely published in national media outlets, academic journals and neurosurgery textbooks. Along with his wife, Sharon, he is the co-founder of Seeking Truth Catholic Bible Study. The couple has five sons. I was very happy to chat with Stephen about society’s troubling move toward embracing physician-assisted suicide, and what it means to “die well.”
Charlie Camosy: It is unusual for a first-rate clinician — in your case a neurosurgeon — to be so concerned about connecting your practice of medicine with your faith. Can you say more about how that came about? How is that received in the broader profession?
Deacon Stephen Doran: Connecting my practice of medicine with my faith reflects an awareness of a (hopefully) past duplicity in my life. As my love for God grows, so, too, does the desire to share him with others. Maybe a better question is “Why wouldn’t I connect medicine with faith?” Fear perhaps? A sense of inadequacy? Like the separation of church and state, I think there was a separation of God from work. Clinicians are encouraged to have a “holistic” approach to the patient, which for most clinicians means addressing the physical and emotional concerns of the patient. But the spiritual needs of the patient are largely ignored. Caring for the sick is a privileged place, and dying is a sacred time. It only makes sense to integrate my faith with my vocation as a surgeon.
How this is received in the broader profession varies. Unfortunately, physicians tend to keep their distance from patients when it comes to their emotional needs, and, even more, their spiritual needs. I think many give the excuse that it would be too exhausting. There might be an element of truth to that excuse, but they are missing out. When faith is shared, the physician-patient relationship is wonderfully enriched. Nurses are different. While physicians direct care, nurses provide care. I know this is a generalization, but in my opinion, they tend to be more open and, as such, faith and medicine are more comfortably held together.
Camosy: The title of your book suggests that we do not die well. Is that the case?
Deacon Doran: Regrettably, I think it is difficult to die well. Death has become medicalized; that is, a patient is seen as a problem to be solved, and death is the failure to solve a problem. To our peril, the spiritual realities surrounding the end of life are largely ignored. This fosters fear and loneliness, which is the antithesis of a good death.
Camosy: What does it mean to die well? And from where do these ideas about dying well come?
Deacon Doran: Someone might presume a good death is a peaceful death. Not necessarily true. Just read the lives of the saints, and you will discover story after story of saints who were tortured, starved, brutally murdered. Some saints felt abandoned, experiencing the “dark night of the soul” before death. So what makes for a good death? Hope. Hope in everlasting life. Hope for the resurrection. These ideas began immediately after the death and resurrection of Christ. St. Paul tells us: “Are you unaware that we who were baptized into Christ Jesus were baptized into his death? We were indeed buried with him through baptism into death, so that, just as Christ was raised from the dead by the glory of the Father, we too might live in newness of life. For if we have grown into union with him through a death like his, we shall also be united with him in the resurrection” (Rom 6:3-5).
The idea of dying well was put into print in the 15th century, when a text entitled “Ars Moriendi“ (“The Art of Dying”) circulated throughout Europe. This booklet of uncertain authorship was written in response to the devastation of the Black Plague, which killed one-third of the population of Europe. It was intended to help the faithful prepare for death. The manuscript begins by saying: “It is very important that everyone should have the art of dying well. … But very rarely does someone prepare himself properly for death at the right time, as everyone believes they are going to live for a long time, and they never believe that they are so close to death.”
The “Ars Moriendi” goes on to describe the things necessary for salvation: belief in Christ, repentance from sin, forgiveness of others, reparation for past offenses. The booklet warns that “those about to die have graver temptations than they have ever had before.” As death approaches, the dying person experiences temptations to lose faith, to despair, and to give into impatience, pride and preoccupation with temporal things.
About 200 years later, St. Robert Bellarmine published his devotional work, “The Art of Dying Well.” Bellarmine begins with what should be self-evident: “He who lives well, will die well.” Furthermore, to die well requires us to die to the world so that we may live to God. The essence of the good life is to cultivate the theological virtues of faith, hope and charity. To live well and die well, we are also called to be obedient and chaste and be ready to meet Christ. We should be detached from worldly riches, avoid “ungodliness,” show justice and live a temperate life. To die well, we should live a life of prayer, fasting and almsgiving.
Camosy: I’m deeply interested in resisting our cultural slouch toward physician-assisted killing, and I know you are as well. Is there a way that you can see a cultural recovery of dying well as part of that resistance?
Deacon Doran: Because the spiritual realities surrounding death and dying are largely ignored, it isn’t surprising that physician-assisted suicide and euthanasia are becoming normative. If the battle against a decaying body and declining emotions is lost, it almost makes sense to end it quickly and supposedly painlessly. But if we understand that we are a unified body and soul, and death is the unnatural separation of the two, then any measures to accelerate the process of dying are an assault on our humanity. The resistance to physician-assisted killing must be rooted in battling against dualism, which permeates our culture in so many negative ways.
Msgr. Lorenzo Albacete wrote, “The culture is defined in terms of how we look at and experience reality. The real choice is between a dualism that separates the sacred and the secular — the flesh and the spirit — and a unified, incarnational vision. All of this is sustained by the grace of the encounter with Christ.”
Also, I think there is a misguided perception that physician-assisted suicide and euthanasia are a good death: peaceful, pain-free, and so on. The reality is that in many situations people die in the exact opposite way they desire. Significant numbers of patients attempting physician-assisted suicide experienced complications, including vomiting, inability to finish the medication, longer than expected time to death, failure to induce coma and awakening from coma.
Camosy: I have it on good authority that the US Bishops are currently considering revisions of the Ethical and Religious Directives. Here’s hoping the revision takes your suggestions seriously, particularly when it comes to putting meat on the bones of the ERDs insistence that patients be permitted to die with dignity in the place where they wish to die.
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Charlie Camosy is professor of medical humanities at the Creighton School of Medicine in Omaha, Nebraska, and moral theology fellow at St. Joseph Seminary in New York.