How do we face death? How can we die well? What are the cultural and medical forces that are leading so many to die poorly? Why are the practices of physican-assisted suicide and euthanasia gaining momentum and acceptance – and why has the Christian pro-life movement missed the deep connection between those practices and abortion?

In this Good Faith podcast, Curtis and guest Dr. Lydia Dugdale talk about life and death issues (literally) that affect every single human being.

Dr. Lydia Dugdale is a professor at the Columbia University Medical School, a national leader in medical ethics, and the author of The Lost Art of Dying.

CURTIS CHANG: Welcome to the “Good Faith Podcast.” I’m your host, Curtis Chang. And the “Good Faith Podcast” is where friends who follow Jesus help each other make sense of this world. Last Wednesday was Ash Wednesday, and I attended my church service. 

I went up to my pastor who applied ashes on my forehead, and she proclaimed to me “Ashes to ashes, dust to dust. You are dust and dust you shall return.” 

In other words, I was being reminded I am a mortal being, and that at some point, probably sooner than I may even imagine, I will inevitably die. And this practice of ashes being applied on Ash Wednesday, it goes back to the medieval ages.  It’s meant to symbolize that we as Christians are meant to carry with us to bear in our very being awareness of our mortality. It also reflects an important truth in the biblical tradition: mortality itself is an important spiritual compass for Christians, that God designed us to make sense of the world through our relationship with death. 

And so the questions came to my mind: how are we doing as Christians in using this compass of mortality to navigate today’s culture? Have we retained the guidance that’s present in mortality? Or are we at risk of losing this tool, losing this wisdom? And so on this week, after Ash Wednesday and as we begin this season of Lent, I thought it would be helpful to ask this question about our relationship to death, and are we holding it and bearing it as a spiritual compass as intended? 

To have that conversation, I’ve invited my friend, Dr. Lydia Dugdale. Lydia is professor at Columbia University Medical School, and she’s a national thought leader in medical ethics, especially on end-of-life issues. She’s the author of a book, a really wonderful book, called, “The Lost Art of Dying,” which I highly recommend, and which I’m sure we’ll talk about in today’s podcast. So Lydia, welcome to “Good Faith.”

LYDIA DUGDALE: Thanks, Curtis, it’s great to join you.

CURTIS CHANG: Lydia, you have written quite a bit about the medical ethics around dying, and at some very high-level journals, articles, books, at other practitioners in the medical field. But I’ve really been struck by how your writing about ethics doesn’t just seem to be philosophical abstractions, but rather born out of your day-to-day practice as a doctor caring for dying patients. You have a clinical practice that focuses on elderly patients, especially as they’re nearing death. So I’m actually really curious: why were you drawn to this practice to actually be engaged in the day-to-day care of dying patients?

LYDIA DUGDALE: Yeah, so there’s a lot to say there. My practice does not specifically only admit folks who are at the end of life.  But, as a general medicine doctor, the vast majority of my patients are baby boomers and older. And so the default in practicing internal medicine is that I do care for a lot of aging patients. But what got me interested in this is a couple of different things. On the one hand, as an early trainee, a medical student, and then a resident, which is sort of the first level of training after graduating medical school, I had occasion to care for many dying patients who frankly were dying in the hospital in situations that either they themselves lamented or their families disdained. And it struck me as very odd that there would be this sort of… Unrelenting clinging to technology that people didn’t want, dying in situations, in environments that they didn’t want.

What was it that left them there? What was it that kept them in the hospital and not making decisions to go home? And so those sorts of questions really gnawed at me. And I started thinking from very early on, there must be a better way as physicians to help our patients think about their finitude, their finiteness, and to prepare for death. 

And certainly, I’m thinking now in that context as a doc, as a doctor in a hospital, how can we help patients either engage with technology or not engage? How do they navigate that? How do they make these decisions? How does that happen in the context of families, of communities, right? 

So that’s the sort of medical side. But then the flip side of it is some of the most fascinating conversations I’ve had with patients have been around questions of their mortality. Medicine can feel very sort of rote and bland. Another patient with high blood pressure and diabetes. Another patient who needs cholesterol medicine. It can just feel like that day in and day out, or, I can create space for considering other anxieties, other concerns.  It has not been uncommon that patients will come in and say, 

“You know, I just had this landmark birthday.”

“I realized I don’t know what I believe.”

 “I’m thinking about my death.”

 “I haven’t reconciled with my kids.” 

Things like that. So these sorts of issues have come in, then we can talk about the preparation for death, not just from the medical, the technological standpoint, but the sort of existential, relational, even religious and spiritual standpoint. The marriage of both of those topics is what drew me to thinking about coming up with a better way of helping my patients prepare for death.

Photo by Aron Visuals on Unsplash