Map of life expectancy at birth from Global Education Project.

Tuesday, August 18, 2009

Strong words

Many of you, like me, have had personal experiences with end of life decisions about loved ones. We are all justly outraged by the truly evil lies of Republican opponents of the current health care reform legislation, including prominent United States Senators as well as the usual gang of gibbering gasbags on the radio and TV, who have succeeded in persuading a substantial portion of the electorate that the provision to have Medicare pay for advance care planning is a plot to murder the elderly and disabled. Robert Creamer thinks it will backfire on them, but I'm not so sure of that. He writes:

In their attempt to enflame the powerful emotions surrounding the deaths of loved ones by spreading intentional lies, the Republicans have stooped to a new low. The Terry Schiavo case should have taught the Republicans that some emotions are too precious to be exploited for partisan political advantage. Apparently it did not.

But when Americans begin to discover just how far the Republicans have been willing to go to stop health insurance reform, they may receive a new lesson. Republicans will learn that combining those powerful emotions with deceit can create an explosive mixture that they will find impossible to forget.

The basic problem, I think, is that the "Christian" "culture of life" is not really about life at all. On the question of the beginning of life, the anti-choice movement is not fundamentally about the supposed sanctity of human life at all, it is about sexual repression and the subjugation of women. I have made that argument here many times and I won't recycle it. What I will concentrate on here is the end of life. Just as they deny human sexuality, these "Christians" try to deny death.

There have been numerous studies that find that people who are more religious, and who use religion to cope with terminal disease, are more likely to favor aggressive measures to prolong life such as feeding tubes and mechanical ventilation. Unfortunately, most of this research is in subscription only medical journals. (Much of this research has been framed in ethnic terms, as the citations below show; but that is really beside the point, it is religiosity which is the focus of these studies.) Quoting Andrea Phelps, et al in JAMA (March 18, 2009)

In a survey of 1006 members of the general public, 68.3% of individuals stated that their religious beliefs would guide their medical decisions if critically injured, and 57.4% believed that God could heal a patient even if physicians had pronounced further medical efforts to be futile.9 Religiousness and religious coping have been associated with increased preference for cardiopulmonary resuscitation, mechanical ventilation, hospitalization near death,10 and heroic end-of-life measures.1 It has been suggested that lower rates of advance care planning among minority patients may arise partly from spiritual appraisals of illness and healing (eg, belief that only God knows one's time to die).11-13

9. Jacobs LM, Burns K, Bennett Jacobs B. Trauma death: views of the public and trauma professionals on death and dying from injuries. Arch Surg. 2008;143(8):730-735.
10. True G, Phipps EJ, Braitman LE, Harralson T, Harris D, Tester W. Treatment preferences and advance care planning at end of life: the role of ethnicity and spiritual coping in cancer patients. Ann Behav Med. 2005;30(2):174-179.
11. Bullock K. Promoting advance directives among African Americans: a faith-based model. J Palliat Med. 2006;9(1):183-195.
12. Crawley L, Payne R, Bolden J, Payne T, Washington P, Williams S, Initiative to Improve Palliative and End-of-Life Care in the African American Community. Palliative and end-of-life care in the African American community. JAMA. 2000;284(19):2518-2521.
13. Johnson KS, Elbert-Avila KI, Tulsky JA. The influence of spiritual beliefs and practices on the treatment preferences of African Americans: a review of the literature. J Am Geriatr Soc. 2005;53(4):711-719.

This may seem odd: one of the most essential beliefs of devout Christians is that death is an illusion and they will be rewarded after death with a blissful eternity. It would seem to make little sense, then, that believers would insist on doing everything possible to delay death, even at the cost of great suffering. But perhaps that's because we're reversing cause and effect: people fervently believe in the afterlife because they cannot accept the reality of death. It's a last resort coping mechanism.

Well, sex and death are yin and yang, after all, and I'm not talking Freudian mysticism. Evolution has programmed us for death because that's the only way to make new generations possible and enable species to adapt. Until taxes came along, these were life's two great inevitabilities. Although we are built to desire sex and fear death there are downsides to both these instincts, obviously. Cultures suppress sexual behavior because it can lead to conflict and damage the social fabric if it doesn't flow in the right channels. And the fear of death is useful only so long as death can, in fact, be avoided. Then it becomes our greatest curse.

The best we can do, then, is acceptance. We have to accept the reality of sexuality and celebrate its expression as long as it doesn't infringe on the rights of others, endanger people, or violate promises. (And don't make 'em if you can't keep 'em.) And we have to accept the reality of death while doing what we can to keep it in its proper time and place. But Christian fundamentalism is, fundamentally, an exercise in denial. It's for people who can't accept things as they are. There is no reason to expect the Christian right to get angry when their preachers lie. That's what preachers are supposed to do.


kathy a. said...

you are preaching to the choir here, so to speak, about the well-funded loudmouth gasbags.

i want to urge caution about painting all religious people with the same brush, because that is neither fair nor true across the board. i'm an atheist myself, but have a good number of religious friends, mainly but not only on the progressive side of things, who are quite thoughtful about issues of death and medical treatment and fairness, and many of whom who put their time and caring into helping others deal with dying or losing a loved one.

you will never convince me that these people aren't saints, or the secular equivalent. they don't make the news, because they aren't gasbags. they care foremost about treating people as humans, and with dignity.

Cervantes said...

You'll notice that I limited my invective to fundamentalists.

Arlington meditation said...

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Cervantes said...

I have no problem with meditation as long as claims about it steer clear of the mystical. It's a good thing to do.