Dying well in today’s world: Medical and spiritual perspectives

Stephen Doran is a permanent deacon (Archdiocese of Omaha), neurosurgeon, and bioethicist. He’s also author of To Die Well: A Catholic Neurosurgeon’s Guide to the End of Life, published recently by Ignatius Press.

The book splits itself between medicine and religion. Part I deals with medical issues around the end-of-life, from artificially provided nutrition and hydration to extraordinary means, euthanasia, brain death issues, issues that surrounded COVID, and advance directives. Part II deals with the spiritual side of death, including suffering, our expectations of “what comes next,” the last sacraments, and Catholic burial.

Catholic World Report interviewed Dr. Doran on his new book.

CWR: In To Die Well, you speak of a genre of literature that emerged around the time of the bubonic plague: Ars moriendi, the “art of dying.” In some sense, that’s what your book arguably is for people today. Why do you see a need for that kind of book today?

Dr. Doran: The spiritual realities surrounding death and dying are largely ignored. Death is more than the cessation of biological function; it is the unnatural separation of the soul from the body.

Unfortunately, the spiritual realities of death are often set aside when the focus is on stopping the decline of the body. Death has become medicalized: illness and death are the enemy, and modern technologies are the weapons to defeat them. In the battle against death, the patient is often reduced to an interested bystander whose humanity or personhood is largely ignored.

My hope is To Die Well will prompt readers to think about the reality of death and spark some conversations. Even more importantly, maybe the book will move readers to contemplate and pray about preparing for death.

CWR: You’re a deacon. How could the Church help people to address “dying well” before they are confronted in person with that situation?

Dr. Doran: It might be just as simple as talking about death and not shying away from its reality.

For example, when I baptize, I often use Romans 6:4: “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.” Our journey towards union with God begins at Baptism and reaches its fulfillment in heaven and then its perfection with the resurrection from the dead.

Also, as St. Robert Bellarmine said, “He who desires to die well, must live well.” Living a life of virtue and frequenting the sacraments is what best prepares us for dying well, and the Church stands ready to guide us on this path.

CWR: To Die Well addresses a variety of issues people sometimes hear about in the press but are not particularly familiar with: advance directives, euthanasia, nutrition and hydration, brain death. You cite Church documents but much of your analysis is natural law-based, e.g., the double effect principle. How much, then, would you say at least that part of your book is addressed to all “people of good will?”

Dr. Doran: The ethical principles guiding decision making at the end of life are not strictly Catholic in nature and, in fact, do apply to all people of good will. While the various Church documents cited in the book put these principles in a Catholic perspective, they are true regardless of religious affiliation.

As Aquinas said, the first principle of the natural law is to do good and avoid evil. There is nothing particularly religious or Catholic about this statement. The dignity of the human person, personal autonomy, the common good, and so on are moral truths that apply to all.

CWR: Your chapter on “deaths of despair” focuses on declining lifespans, fast deaths by opioid overdoses and slower ones by alcohol. How much of this is economic and how much of this is a despair about “meaninglessness” in life? What do you say to the ennui, the “whatever,” one even hears from the young, manifest in suicide rates?

Dr. Doran: If you believe the data from Case and Deaton, economic disparity is at the root of “deaths of despair.” They mined data from the CDC and found that white, middle-aged men were dying earlier than at any time in the past hundred years. Suicide alone could not explain the increase in rising death rates, but when deaths from drug overdose and alcoholic liver disease were included, the excess mortality could be explained. White, middle-aged men were killing themselves: sometimes abruptly through suicide, sometimes more slowly through drug and alcohol addiction. The majority of those dying a “death of despair” were from the working class without a college degree.

Many factors can contribute to a sense of meaninglessness in life, but the stresses associated with low income without a doubt pour gasoline on the fire of despair. As for the ennui, I believe there is a pervasive sense of listlessness that weighs us down like a wet blanket. Yes, people get fired up over cultural war issues, but by-and-large, I think people want to escape, tune out. Christ calls us out of tepidity, “I know your works: you are neither cold nor hot. Would that you were cold or hot! So, because you are lukewarm, and neither cold nor hot, I will spew you out of my mouth” (Rev 3:16).

CWR: Powerful forces are assembled to bend medicine to a culture of death. In Ontario, for example, physicians are expected to refer patients to other practitioners if they will not participate in “medical assistance in dying.” In the USA, some professional associations agitate to demand abortion training for aspiring OB-GYNs. How do you see the infiltration of the culture of death into North American medicine, and what would you say to a pro-life Catholic who wants to join those healing professions today?

Dr. Doran: Certainly, there are individuals and organizations that are promoting abortion access and in doing so, apply inappropriate pressure on medical practitioners to be unwilling participants. I would remain hopeful and not discourage pro-life Catholics to pursue careers in healthcare. Only about 20% of OBGYN’s offer any type of abortion services. There are ample opportunities to practice in this or any other field in medicine without compromising moral principles. If anything, there is an imperative for pro-life Catholics to be the voice of reason and faith in the face of a culture of death.

CWR: Your book is replete with personal examples of the theoretical issues you discuss, be they medical or spiritual. Many of your examples address sudden death, e.g., cerebral aneurysms that rupture, placing otherwise healthy patients in immediate mortal danger. As a doctor and a deacon, could you comment on the rapidness and sometimes unexpected nature of death, something rarely discussed today?

Dr. Doran: Scripture advises us, “stay awake, for you know neither the day nor the hour” (Mt 25:13). I think we really need to take this to heart and live ready, and that means frequenting the sacraments, especially reconciliation. While in our minds we acknowledge the inevitability of death, in our hearts we see it as something happening to someone else in the distant future.

There is a curious denial about the reality of death; a sudden death may temporarily jar our psyches, but then we go back to business as usual. A natural defense mechanism is to put at arm’s length that which disquiets our souls. But if our desire is to be in union with God, death, while sad, is the way by which our greatest desire is fulfilled, regardless of whether it is anticipated or out of the blue.

CWR: As a deacon, you have probably preached at funerals. Funeral homilies are not eulogies, paeans to the deceased. What goes into a Deacon Stephen Doran funeral homily?

Dr. Doran: I love the invitation to prayer at the vigil service, “My brothers and sisters, we believe that all the ties of friendship and affection which knit us as one throughout our lives do not unravel with death.” Death is not the end. There is no death in God. While our bodily death is the necessary gateway to heaven, this fulfills our greatest desire: union with God. The resurrection of Jesus gives us the hope for our own bodily resurrection, and the unnatural separation of the soul from the body will be remedied.