Is there a Christian response to the growth in medical technology?

I was called into the hospital Intensive Care Unit late one night at the request of an elderly man whose wife of 83 years was not doing so well after a coronary bypass. The husband looked a diminished figure sitting by his wife in the midst of the usual tubes, monitors, respirators and a machine that was helping her heart pump enough blood to keep her alive.

The nurse in attendance was abrupt and tight-lipped. When I asked her how her patient was faring she told me that there was little hope of her survival. She went on to deplore the fact that the surgery had been done. She was of the opinion that this woman could have led a quiet life at home with her husband of some years until hear heart disease finally caught up with her. Instead, her life had been shortened and her husband had found himself in an alien environment holding his dying wife's hand.

While I do not wish to imply that the surgeon's decision on a course of action is at all easy, this case seems to highlight our dilemma as our technology becomes more powerful and its use more imperative. It is very difficult for patients and their families to make good choices when confronted by a surgeon telling them that they either have the procedure or die. The following issues arise.

Governments all over the Western world, in which medical technology has been highly developed, see an explosion in the cost of medical care. A large proportion of this cost is incurred in looking after people in the last years of their life. When us baby boomers reach our 70s and 80s, medical science will be able prolong life more and more and the economic repercussions will be enormous. There arises the possibility that a large part of our gross national product will be spent on extending life by a few years. In the extreme, we now have people talking about the existence of the last mortal generation and of slowing or stopping the aging process.

Secular ethics, based on human rights, is powerless to speak constructively to the question. It is of the nature of human rights that they are boundless. Rather than providing a basis on which ethical questions may be discussed they simply assert the rights of the individual in isolation from the concerns of the community in which that individual lives. There is no way that a person's rights may be examined, they are simply asserted and the issue decided on the grounds of discrimination. This is like writing a blank cheque on the resources of communities. Talk about the sanctity of life will not help us in this because it is easily turned into a moral absolute divorced from specific cases.

Western medicine has its origins in the Christian tradition that refuses to rank human beings according to worth. This tradition is carried on in our hospitals in the way; for example, the terminally ill are cared for. The egalitarianism of those "in Christ" is carried into our care of the sick. This is because the idea of egalitarianism readily finds a place in the modern ethos that has been formed by the revolutionary movements of the West.

However, other aspects of the Christian tradition have not been carried into the present. These have to do with our attitude to death. It is the absence of these traditions, in an era dominated by the subjectivity of the individual, that have left us in an ethical void. We find that many want to postpone death as long as possible and will take almost any steps to do so. It seems that when the surgeon gives the alternatives of death or surgery there is no choice even when the disease is wont to run its course. This is particularly agonised when the decision is left to a member of the family. While the person involved may not feel that the promised extension of life is worth the further trauma and risk of surgery, a decision to refuse treatment is difficult in the face of their loved one's concern and an enthusiastic medical practitioner. Our question in all of this is to do with a Christian tradition that enables us to incorporate our deaths into our lives in a faithful way.

What enables Christians to deal with dying in a way that does not attempt to do away with dying? How are Christians able to "square off" to a terminal diagnosis, albeit with much pain and regret, in calm and in peace? In an age in which death is seen as failure, how do Christians come to acceptance and to finish their lives in trust and hope?

For much of the history of the church the answer to the above questions has been to say that the person who dies goes to a better place, that death is but a "going around the corner" and is not, in fact, a loss of the self.

Biblical research reveals that the gospels are oriented not towards the survival of the individual after death but to the dawning of the earthly reality of the kingdom of God/heaven in Jesus. The life to come is not, in fact, life after death but the life that comes at the inauguration of the kingdom present in the person of Jesus and for those who follow him. It is called "eternal" because, like God, it does not pass away with time.

In Mark the first words spoken by Jesus announce this orientation: "The time is fulfilled, and the kingdom of God has come near; repent, and believe in the good news." (Mark 1:15) The gospel of John has a slightly different orientation to the present reality of eternal life. The emphasis on the immortality of the soul has come from an uncritical adoption of NeoPlatonism by the church. In contrast, the emphasis of the New Testament is upon the establishment of a new order of earthly reality.

Modern research into the dependence of consciousness on the integrity of the brain has lead to the break down of mind/body dualism. That is, when the body dies, the self dies. The resulting materialism is affirmed in the Old Testament: "By the sweat of your face you shall eat bread until you return to the ground, for out of it you were taken; you are dust, and to dust you shall return." (Gen 3:19)

This does not mean that we do not, in some way, "go to God" in death but that the Christian construction of death as a simple transfer to another and more glorious room is mistaken both in terms of what we know about the materiality of the self and of the major thrust of the New Testament. Our task of defining Christian hope in the face of death is thus more nuanced and, we hope, more biblical.

What is there in the Christian tradition that trains us to live loosely to our lives and to not mistake longevity with the life promised by the gospel? The gospels tell us of Jesus who knew that there were some things more important than dying. If he had not known that he would have surely skipped out over the hill to Galilee and safety. But as it happens we have the record of his agony in the garden of Gethsemane and his resolute journey to the final conflict.

The three synoptic gospels draw this agony in the starkest terms and the conclusion that Jesus shrank back in horror at the fate that he saw before him is inescapable. Thus there is in his response to the coming events no glib presumption of a glorious outcome nor fatalistic acceptance of it but a real encounter with death.

A resort to the resurrection may not soften the sharpness of this; the dying of Jesus was a real dying. The raised Christ is also the crucified Christ as is witnessed by the texts that have him showing the disciples the holes in his hands and his feet. The raised one does not die again but, according to Luke and John, returns to the Father to become an aspect of God.

We must, therefore, take Jesus' journey towards death as a real journey to personal oblivion. As followers of Jesus in the things that were central to his life we too are called to face death as an erasure of the experience of self. Certainly we join the communion of saints in death but that communion is not a communion of the self-conscious dead but a communion of eternal memory and as such is a part of God.

The rite of baptism says as much. The baptised one is understood to go down into the waters of death with Christ and to be raised to new life with him:

I have been crucified with Christ; and it is no longer I who live, but it is Christ who lives in me. And the life I now live in the flesh I live by faith in the Son of God, who loved me and gave himself for me. (Gal 2:19,20)

According to the writer of Colossians 3:3 our lives are "hidden with Christ in God." There is a strong sense of our lives being taken from us only to be given back "in Christ". The parallel idea in the gospels is the saying about losing and saving ones life: "For those who want to save their life will lose it, and those who lose their life for my sake, and for the sake of the gospel, will save it." (Mark 8:35 and parallels)

For Paul, this is about freedom from the law/flesh/elemental spirits of the universe and death. We live at a remove from our lives, in which death has no dominion, even though we die. But it is just this remoteness that is the promise of having our lives to the full. In other words our lives are not governed by the reality of death but by the grace of God shown to us in Christ. The essence of all of this is taken up in question 1 of the Heidelberg Catechism of 1563: "What is your only comfort in life and in death? Answer: That I, with body and soul, both in life and in death, 'am not my own', but belong to my faithful Saviour Jesus Christ".

Christians are the ones for whom death has lost its sting, not in that death has been removed from the earth but that, living in Christ, death has no dominion over us. Death does not poison our lives with dread and desperation. This is what eternal life is, not the eternity of the self but the presence of God that turns the time of natural process into the eternal time of God. Nowhere is this more obvious than in the gospel of John in which eternal life is a present reality for those who believe. "And this is eternal life, that they may know you, the only true God, and Jesus Christ whom you have sent." (John 17:3)

Popular religion is most often a response to the reality of death. When religion has the fear of death as its point of fixation and origin we find ourselves completely under the dominion of death. Death determines our hope. The agony of the patient is often that the only hope they see is in the expertise of the surgeon. This is a hope that promises but more of the same. By contrast, Christian hope is conditioned to look for the promise hidden in the future as a new and unexpected work of God. It is often the case that the patient is not told the truth about their condition because it is thought undesirable to remove all hope. But the hope that we have in Christ is not negated by the imminence of death. In Christ the religion of death is replaced by the religion of grace and love and life.

Christians are in a position to confront the runaway phenomenon of medical science by showing, in the lives that they live, that death has been displaced by the Lord of life. When the terminally ill grasp after any procedure, no matter how heroic, to extend their lives, they demonstrate that death is the lord of life. When Christians in the same situation refuse further treatment of a terminal condition, other than the palliative, this is not a denial of life but an affirmation that their lives are not ruled by death but by something much greater. In the face of this something that is much greater, death, while still being of great consequence to us, does not have the final word.

When our medical profession takes death to be the enemy to be opposed to the last gasp, literally, death increases its power in our lives. This amounts to a demonising of death and is the engine that drives our medical services out of control. While our hospitals are marvels of technology and management but also of care and compassion there is the danger that they will become symbols of human self-deception telling us that all may be cured. The medical profession already labours under the increasing expectation of relief and cure. As we invest more and more in medical care this can only increase and we may have a population so focused on staying alive that they will forget to live and to take the risks that living inevitably entails. Then life would truly be death-bound.