The debate about death with dignity needs the wisdom of the Catholic spiritual tradition, says this physician and bioethicist.

If you've never had to make an end-of-life decision for a loved one, you probably will one day. Eighty percent of hospital deaths now involve an explicit decision to stop some form of treatment. When you make this decision, your stress level will be the equivalent of someone whose house just burned down. And if you've never actually talked to your loved one about how they want you to make that decision, your chances of correctly guessing what they want is only two out of three.

Startling facts such as these roll off the tongue of Dr. Daniel Sulmasy, O.F.M. as casually as another doc might say, "Take two aspirin and call me in the morning." One of the nation's premiere bioethicists, Sulmasy wears a number of hats in his work at the University of Chicago: Along with being a physician who sees patients and an ethics professor, he teaches in the divinity school, and he's a Franciscan friar.

Known for tackling tough ethical issues, Sulmasy specializes in decisions at the end of life as well as the spiritual dimensions of practicing medicine. Not surprisingly, he thinks those two are inextricably linked.
Lest anyone think that dealing with life-and-death medical issues all day would be a downer, here's what Sulmasy told the Chicago Tribune on his appointment to the Presidential Commission for the Study of Bioethical Issues: "I have to say not many people have it as good as I do."

Why should health care providers be a part of the conversation about the spiritual care of the dying?

Because medicine is inherently spiritual. The first healers, the shamans, were both priests and doctors. There's something very significant about the interaction between a healer and a patient that raises the big questions, although physicians sometimes don't allow people to ask them: Why me, or why my child? Why am I suffering? What's the meaning of this?

If we're committed to healing patients as whole persons but don't address those kinds of questions, then we're negligent in our work as physicians. If all I'm doing is giving chemotherapy, I'm missing 99 percent of the picture.

Is there a special connection between Christianity and medicine?

What did Jesus do during his life? He preached and he healed people. Among his first commandments to the disciples is, "Go out and heal people," and that's what they do. Read the Acts of the Apostles-it's all preaching and healing.

For Christians healing has this incredibly special status as an announcement of the kingdom of God. While the miracles of the Old Testament are the parting of seas and pillars of fire, the miracles of the New Testament are healing miracles.

With the advent of early Christianity and even up to the Middle Ages, religion--particularly Christianity--and the scientific medicine of the day are joined. The first hospitals were monasteries. Think of the stories of the St. Bernard dog, going out into the snow and bringing the person into the monastery. The monk-herbalist was the physician. The word hospital comes from the Benedictine virtue of hospitality, of welcoming the sick as guests.

Then with the Renaissance and the Enlightenment, the sense grows that medicine is scientific and religion is superstitious, and that gets in the way of health care. This gradually builds until the middle of the 20th century, when the connection falls apart completely.

Why then?

Partly because medicine became so powerful in the 20th century. Until the advent of antibiotics, doctors couldn't really do very much for people. But since the 1930s, the advances in medicine have been so astronomical that people look not to God but to the doctor when they're sick. The doctor begins to think, "I've got the power." There's this continual suspicion that religion gets in the way of medical progress. When I was in medical school, the patient history form used to ask what the denomination of the patient was. Even that's disappeared.

Both as physicians and as patients we've alienated ourselves from the central meaning of the work by lusting after the technology. We've allowed it to be a stumbling block to a truly integrated holistic form of medicine.

So the chaplains go about their work. The physicians go about their work. They're parallel but not really in concert. For most physicians the work of the chaplain is not really part of medicine. And doctors often think religious people just get in the way--that some fundamentalists will come and ruin our ideas of the best way for this patient to die, or some bishop will tell us that what we want to do scientifically is wrong.

Is there any movement away from the total focus on technology in medicine?

I think both patients and clinicians are experiencing a kind of spiritual bottoming out. The soul seems to have gone out of medicine. Patients feel alienated now by the very progress they were looking for; they feel they're being treated like machines.

A lot of medical professionals now are saying, if I'm just going to do colonoscopies 20 times a day on patients, I might as well be working in a poultry processing plant. This is not the human experience that both patients and physicians know, in the depths of their souls, medicine actually should be.

I think the inherent contradictions are beginning to dawn on people. Spirituality is being taught in some medical schools now. The number of medical students reporting they feel they have adequate education about death and dying--the time when spirituality comes into play so frequently--steadily increased significantly from the mid-1990s until the mid-2000s.

So how does this all play out in death and dying today?

There are forces going in multiple directions at the same time. On one hand you've got people who are denying the reality of death and seeking every kind of treatment. There are physicians who will never stop treating a patient until their very last breath.

On the other side you have people pushing euthanasia and assisted suicide. Ironically, Dr. Kevorkian's Mercitron machine is actually a child of the same belief in technology, because the solution offered by the advocates of euthanasia and assisted suicide is still based on technology. When the technology of curative medicine fails us, then there will be another technology that can save us--Dr. Kevorkian's Mercitron machine.

What's the alternative to "fighting till the end"?

We're all going to die. Continuing to deny that gets in the way of coming to grips with our humanity and all the important things that we need to do during that period, which can be incredibly rich. Sometimes I enter the room of a patient, and they're dying in faith and hope and love. I want to take my shoes off before I go into the room. It's holy ground that I'm treading.

I'm powerfully transformed by that. It's part of what keeps me in medicine. To see people who really get it, who understand that they're dying, who are surrounded by people who love them, who care for them. They are dying in love with God, recognize they're going into the arms of God, and this teaches me about the meaning of my life.

These patients have given a great gift to me, to see that this kind of dying is possible.