CPE reflections (5)

5. The Needs of the Dying

Of all the readings for the introductory Clinical Pastoral Education course, I found the paper by David Switzer on the ‘Nine Needs of the Dying’ the most frustrating. Switzer identifies the following nine ‘needs’ that people facing death observably need (or say they need):

1. Expressing feelings
2. Overcoming loneliness
3. Meaning in the present moment
4. A sense that one’s life has been meaningful
5. Consistent messages
6. Regaining (at least some) control
7. Continuing to feel useful
8. Having one’s spiritual needs met
9. Letting go

If we accept the claim that these needs are purely descriptive, then they provides helpful ‘hooks’ to assist those who are ministering to a dying person to work out ‘where they are at’. This can help us care for a patient who has come to terms with her present condition — and made sense of it — while still living with (painfully) open questions about what legacy she’s left.

Unfortunately, the paper doesn’t rest content with description but everywhere assumes a normative standpoint about how to deal with these needs. It is highly value-laden: Why do dying people need these things? Simply because they say they do (in which case we’re really speaking about ‘wants’ rather than ‘needs’)? Or, as Switzer hints numerous times, because if these needs are satisfied then a death is somehow good?

For me, this opens up some big questions. What stirs me up most is the way Switzer seems to suggest that death is a natural fact. Something that’s almost bland. To be accepted not raged against. Faced realistically not denied. Made peace with not treated as an enemy.

However, the biblical presentation of death feels a lot more equivocal. On the one hand:

• Death is the last enemy — finally overcome and plunged into the lake of fire at the end of Revelation.
• Jesus triumphantly conquers death in his resurrection, securing a future resurrection for all who trust in him and pouring out the Spirit of life upon us even now as we remain subject to death and corruption in our bodies.
• It may just be my ignorance, but I can think of plenty of Psalms that plead with God for deliverance from (impending) death; none that ask for peace to be made with death.

Death may be unavoidable (assuming Jesus doesn’t return first), but it’s unnatural, it’s not right! If it’s a necessity, it’s a tragic necessity — never something to make peace with.

On the other hand, I think there are hints in Scripture that death is thoroughly ‘natural’. I know that Paul says death entered the world through humanity’s sin (Rom 5.12-21) — and it can be right and even good in so far as it’s the form taken by the holy and righteous judgement of the holy and righteous Judge in the presence of human sin — but there seem to be some hints in Genesis 2 that (a) human beings are not naturally or inherently immortal, and (b) the second law of thermodynamics — that things tend to decay — didn’t spring into existence at the Fall.

Adam was formed from the dust outside the Garden. Only then was he placed in it. Consequently, if we, following say Dumbrell (The Faith of Israel), take the Garden as kind of ‘sanctuary’ — a place of special and privileged relationship with God (it is after all where Adam and Eve encounter God walking in the cool of the day) — then we see a hint that relationship with the Creator and source of life is not natural to human beings; rather, it is a gift of grace, a result of God’s action for humanity.

This is reinforced if we ask how Adam and Eve were going to live forever (had they not sinned). The ‘mechanism’ seems to have been eating from the tree of life. Once again immortality is not something that’s ‘built in’ to human beings; rather, it’s a product of access to the tree of life, which is itself premised on proper relationship with God (Adam and Eve are cut off from it when God expels them from the Garden).

My second suggestion is more controversial: the second law of thermodynamics didn’t spring into existence at the Fall. (Neither, I take it, did all the cellular mechanisms by which life and death are bound together: all cells have cycles and mechanisms, not only for repair but also for growth and reproduction, which are premised on their ageing and dying — skin cells, for example, are constantly dying, flaking off, and being replaced.)

One reason for making this suggestion is the apparent contrast between the Garden and the rest of the world outside its walls. The Garden is a place of order, harmony, productivity and peace. With human beings to work and cultivate it (in partnership with God), it answers the lack highlighted at the start of the chapter: ‘no plant of the field was yet in the earth and no herb of the field had yet sprung up — for the Lord God had not caused it to rain, and there was no one to till the ground‘ (Gen 2.5). Presumably this applied to the whole creation, hinting that part of humanity’s task may include extending the ordered productivity of the Garden to cover the face of the earth. This suggests that the peace and life characterising the Garden didn’t necessarily apply to the whole world — at least not yet. Death may have reigned — among animals, plants, etc — outside the Garden.

There is thus a sense in which death is natural. And yet the fact that it stalks humanity, casting its terrible shadow — decay, disease, ageing — over us and the world in which we live, is deeply … wrong. A consequence of human rebellion (and God’s judgement upon it). Not His original intention.

And He graciously wants to give life to our mortal bodies — hence resurrection hope, the implications of which are nothing short of liberation for the whole cosmos to share in the glorious freedom of the children of God (Rom 8). It is out of this hope that Christians minister to the dying — not out of a humanistic conviction that it’s important to tie up loose ends, deal with unfinished business and make peace with your impending passing.

You die well if you die in this hope. Not if you’ve ticked off nine (observed) ‘needs’ of the dying!