Framing Pain as Necessary.

It's been quiet around here -- and I have some good excuses -- but there's nothing like a prompt from a friend and the romanticized notions of pain in David Mills recent column for First Things, "Death Dignified by Christ" to snap me out of my pressing distractions.

Mills is the deputy editor of First Things, a historically Catholic site that has been flirting with keeping the big C on the down-low and bringing in various other voices to freshen up their demographics. The print magazine (which still exists and this month features the likes of Stanley Hauerwas, Ross Douthat and Dinesh D'Souza) was founded by the Anglican-turned-Catholic priest, Richard Neuhaus, who wrote often movingly about American life in the "public square." (Nathan Schneider pointed us to Alan Jacob's review of American Babylon, Neuhaus' last book before he died in 2009. The review slights Neuhaus for failing to move into the digital public square.)

First Things is also the blog-home of the scoundrel Wesley J. Smith (I'm taking license, maybe, but he does appear in a leather jacket in a publicity photo and pick a lot of fights), a vocal and long-time confuser of the facts regarding end of life care, assisted suicide, and health care. Smith's taken his "anti-euthanasia" show on the road to countries where bills have been considered and his views have had influence over U.S. presidents as well. I've spent a lot of time debunking Smith, when in my blogging swing, because he exemplifies what American media get so wrong about health care and end of life care. In other words, Smith works within a common frame of understanding that is grossly divorced from how health care really works.

But back to Mills. A writer and editor, Mills has headed a number of prominent and award-winning Episcopal and Catholic journals. He's also a member of the National Organization of Episcopalians for Life (NOEL), now called Anglicans for Life. It's a group with what first appears to be a singular, stated focus: to end legal abortion. Yet, such a crusade -- and I mean to imply that AoL, like most "pro-life" groups are religious in nature -- rests on a moral opinion of human sexuality, not on actual human behavior. I point this out because Mills' recent article for First Things too has a singular stated focus, one which is more difficult to frame than the issue of abortion. (In the prevalent and successful narrative against abortion babies are cute, even if they're hypothetical; it's hard to get many segments of the American public upset about the slighted reproductive rights of women; suffering poor health or an unwanted pregnancy is "acceptable" punishment for immoral acts, like sex.) Mills is out to emasculate the Death with Dignity movement.

In "Death Dignified by Christ," Mills glorifies suffering as a redemptive, saving force. His essay is really just a reiteration of the old theological answer to the even older question, "Why does God make us suffer?" To punish us for our "immoral" acts is the answer for abortion (or to teach us the beauty of babies and discipline). But that doesn't fly so well with today's baby boomers who are facing modern and painful ways of dying. They've got less of a grip on their need for punishment. (Which is why Death with Dignity is currently legal in three states in the U.S. -- Oregon, Washington, and Montana.) So the religious/moral arguments that have been so successful in the erosion of women's reproductive rights don't fully work when used to address end of life suffering.

Beyond Mills' assertion that we should all be subject to his interpretation of God's laws, he resorts to Smith's common approach: degradation of those who want to end their suffering. In writing about his dying father, Mills says he "took it like a man," as if dated concepts of gender and masculinity are enough to convince us that suffering is a show of strength. Those who consider assisted suicide are, he writes, "declar[ing] yourself God," and choosing an end "without fuss or bother or pain." (Try that one on Robert Baxter.) Dying means to suffer, he tells us -- and suffer is loosely defined in the article as inclusive of being alone, losing our faculties and being "dressed by cheerful young women the age of your granddaughter."

By perpetuating the idea that suffering is strength, Mills would like to make heroes of those who approach death in pain. Forget Cicely Saunders' concept that pain is relative and varied. (Saunders, a devout Catholic, founded the modern hospice in the late sixties/early seventies, in part to combat the "euthanasia" movement.)

Death and pain are irrevocably tied in Mills' assertion. But they don't have to be so in our hospice facilities and hospitals. The medical world possesses methods of controlling pain. And if that fails, we all own this body that carries us around; who's to say we shouldn't escape death when we're ready -- regardless of the place we plan to visit afterwards? Glorifying suffering or asserting that pain is a necessary part of dying ignores the medical advances of the past 50 years (for patients' good and bad) and perpetuates inhumane and unnecessary ideas about rights at the end of life. We have the right to die peacefully, without pain, regardless of what we believe. Mills and others are successful in perpetuating the myth that pain makes us better, redeems our immoral behavior, and is inexplicably tied to the dying process. But why are they? Why do all but 20% of our seniors die in the hospital when 80% wish to die at home? Why are discussions of patients' desires at the end of life seldom had? Why is it shameful to accept declining functionality and frailty? To suffer pain without seeking medical treatment?

Take God out of the question and you get, "Why do we suffer?" I would say we suffer pain at the end of life because we wrongly think we have to. For the lucky of us, our diligent hospice nurse is working her heart out on our appropriate medication dosage.

(h/t Carla Axtman)