COVID-19’s impossible choices: What is the church’s ministry to the dying?

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Published April 2, 2020

Thirty years ago, in seminary, we would often talk about the situations and emergencies that might overcome us in ministry. We talked of the history of cholera epidemics, of plague, war and disease. We learned the stories of heroic clergy who ministered on frontiers when disease would sweep through settlements. We questioned what the “right thing” in ministry would be in such situations. We talked about the ministry of the church in those times. We also learned faithfully through our clinical training the “right way” to do pastoral visits and ministry at the time of death. We had no frame of reference for the images we have seen in the past two months from around the world—of coffins stacked in Italian churches or weeping doctors and nurses who have worked themselves to exhaustion. Nothing we learned prepared us for this.

Bishop William Cliff. Photo: Diocese of Brandon

So now the whole world is thinking more urgently about dying. Christians are supposed to consider the issue of dying theologically: how we die, when we die. What comforts will be there at the time of our death? Images and stories from Italy, where thousands have died in hospitals, are accompanied by stories of those whose age or infirmity had them triaged away from hospitals and ventilators and sent them home with the assumption they would not survive. It was decided that these people should at least die in comfortable surroundings, either by a conscious choice or because of lack of beds. Worse yet, was the discovery of the dead in their beds in nursing homes in Spain—abandoned and alone, with no one watching over them. These are terrifying images, terrifying decisions and terrifying days.

The first thing that has been destroyed in this pandemic is our illusion of autonomy. The idea that one has a choice about lifestyle, travel or simple freedoms has been exposed as false. The church has been saying for some time that the self-centered and self-reliant society we have been building for the last decades is an illusion. All it took was a virus—some RNA wrapped in a lipid protein—to prove it. The terror we feel is not only existential; it is compounded by a loss of control, and grief, as we lose loved ones without recourse to our usual comforts.

In a recent article in the Ottawa Citizen, palliative care physicians reminded our strained-to-bursting medical system that it cannot simply walk away from those for whom an emergency triage may send them home to die. We are not in Italy’s situation, but we could be walking the same road within a week or two. These palliative care doctors, who particularly serve the dying, remind the rest of the medical establishment that even in a pandemic, comfort care (or in this case “palliative sedation”) is still both medically necessary and a matter of human decency for those who choose not to be intubated or wish to go home to die untreated.

So what counsel might the church have to offer in the midst of this crisis?

Spiritually, nothing in a Christian’s life belongs to them. If we have been baptised into Christ’s death, and our life is hidden with Christ in God (Colossians 3:3), then it follows that our death is also not our own.  Generations of Christians who survived disease, starvation, plague, war and pestilence knew this. An example of the moral obligation to act to relieve suffering and intervene is brought into sharp focus by Aristides de Sousa Mendes. Punished for protecting Jews and issuing visas and passports by the Salazar government in neutral Portugal during World War II, Aristides was recognized as “Righteous Among the Nations” by Israel in 1966. His explanation of his actions and resignation to the punishment he received may be instructive to us now, in our different context: “Starting today I will obey my conscience. As a Christian I do not have the right to let these women and men die.” It was not a pandemic, but those were equally life-and-death decisions.

For Christians through the ages, the idea that one was supposed to be somehow immune to these sufferings was as far from Christian consciousness as the east was from the west. To be faithful was to be humble before God, for no one knew when one would be called to eternity. This is a world that had been consigned to history—or movies—away from our developed-world experience. These last few weeks, everything has changed. We find ourselves standing in the same place as generations past; those for whom death came early, or swiftly or painfully or while alone and far from loved ones.

In the letter to the Romans, Paul wrote, “We do not live to ourselves, and we do not die to ourselves. If we live, we live to the Lord, and if we die, we die to the Lord; so then, whether we live or whether we die, we are the Lord’s.” (Romans 14:7-8) This is where we must begin to root ourselves: in Christian hope. As a church, if we advocate for those who are vulnerable and then denied intensive care simply because of circumstance, for what shall we ask?

Comforting the dying is core to the church’s mission. It is evangelical in that it teaches those who observe our concern and care for the dying, the Christian doctrine of the value of life. In sacrificing to comfort those who are at the end of their life’s journey, we are caring for the “little Christ” we all became in our baptism. Each bedside can become the foot of the cross for loved ones. Caring for the dying also testifies to the world that in Christ, while we may grieve a death and may even be inconsolable, we do not despair. In normal circumstances, our spirits rebel at thinking of these sacrifices. “It should not be so!” we explain to ourselves, but our facade of control and comfort has been torn away. Those in the intensive care units in Bergamo, New York and Madrid already know this. Now they are making the unthinkable decisions that may face us: having to choose to whom limited resources are applied.

It may be our ministry to remind our harried and heroic medical establishment that those who have declined or been designated not to have treatment for the worst of COVID-19’s process are still worthy of medical comfort and care. Even with resources stretched to the breaking point, both young and old must have access to care which does not injure their dignity. Palliative sedation means there is no cause for anyone to die in distress. Nor is there need for death to be hastened by interventions with cocktails that restore an illusion of control. Our Christian faith lays upon us an obligation. We must be prepared to care for those around us, even those who may have been forgotten. That care may be costly, and it may include impossible choices.

Perhaps we need reminding that waiting with someone who is in the process of dying is a holy place. Bishop Jeremy Taylor, 17th-century bishop of Down and Connor, wrote extensively on how the Christian ought to view dying, and our duty as Christians to both prepare for it and comfort those who suffer.  He wrote in one sermon, “Certain it is, that as nothing can better do it; so there is nothing greater, for which God made our tongues, next to reciting His praises, than to minister comfort to a weary soul.”

This crisis is reminding the church of many things, of which our mortality, our vulnerability and our responsibility to one another are just a few. It is also drawing us out to become more loving, more caring and sacrificial in our love for one another. The complicated, cruel and death-denying world which has been constructed for us is being dismantled. Let examples of love, compassion, mercy and sacrifice be our motivation and, if necessary, our epitaph. Now is exactly the time that what we preach should be manifest in advocating and protecting those who are on the very edge of eternity, for we believe we will see them again and give to God an accounting for the care we have offered.

The Rt. Rev. William Cliff is the bishop of the diocese of Brandon.


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