John Paul II's death affirms the value and dignity of life for this Jesuit gerontologist

Where do we start when we think about the end of life and caring for those with life-threatening illnesses? Often it's with talk – talk about ethical dilemmas, problems with health care, or controversial cases.

I don't think those are good starting points for Christians. The best place to start is with our faith that Christ died and rose from the dead and that our own dying is how we enter into eternal life.

I am a Jesuit priest and physician whose medical practice is in geriatrics and internal medicine. I focus on the care of older people, in many cases those who are dying. In my teaching and in my writing I am very involved with how to improve the care of the dying.

Jesuits speak about the struggle for faith and justice. If we are considering end-of-life care and forget our faith, we do the dying an injustice because we lose our own inspiration to care as Christ did. We also act very strangely if we believe death is always to be resisted, or if we pretend death is no big deal, or if we think that we are in control of life and death.

It is just as worrisome when we act as if death will never come, when we pay little attention to the practical things that can make the end of life easier, and when we avoid thinking about the needs of those around us with life-threatening illnesses. If we don't start the whole process with faith and justice, then we easily slip into polarization: thinking that euthanasia and assisted suicide are merciful and rational, or being overzealous in insisting on aggressive life support.

My Catholic tradition and my Jesuit spirituality provide a wonderful combination to act with faith and justice. My work with health care professionals in the care of those facing the end of life provides a crystal-clear lens to focus the truth that faith in Jesus Christ compels us to be with the dying, to ease their pain, to consider better strategies for care, and to attend to spiritual needs as well as symptom relief.

As a Jesuit, I find God in the efforts of so many wonderful people-nurses, aides, other physicians, family members-to make the dying process peaceful and a time when the person can look to God.

When I am caring for an individual in a personal way, it is hard not to be moved when I recognize that my priesthood includes the opportunity to anoint, to be a minister of reconciliation, and to provide viaticum, while those things that are part of being a physician allow me to treat pain, to relieve symptoms, to be with my patient, and never to abandon a patient to the experience of illness. And I find God's help in some of the conflict and difficulties in this area where there can be so much unnecessary confusion, discord, and evasion of responsibility. Being a Jesuit in end-of-life care can mean, in a very nondramatic and often exquisitely quiet way, to campaign under the banner of the cross.

In a culture where media loves controversy, where the reality of the end of life is hidden by sensationalism, and where we can miss the point that the purpose of our living and dying is focused on God, it is easy for conscientious people, people of good will, to become very frightened about end-of-life care.

That leads me, a Jesuit looking to the events of the world for the presence of God, to ask if anyone was paying attention to how John Paul II died this April. He died not in a hospital, not in an intensive care unit, but in his own bed.

What can we learn from these facts? For me, three things stand out.

First, this remarkable man who led the Catholic Church for my entire adult life taught me about the value and dignity of life and the grace of a natural death. His example reinforced the teaching that a natural death is part of life and that when an individual is clearly dying, one need not use every measure to resist that death.

He affirmed in his illness and death the value of life, and he did so in an age when some treat life with contempt, especially in their attitudes toward the elderly, the disabled, and those with chronic illnesses. We all know people who, confronted with an octogenarian suffering from Parkinson's disease and other infirmities, just like John Paul II, would consider him a candidate for assisted suicide if not euthanasia.

But the Holy Father taught the world a valuable lesson about the dignity of life that is present even in an old man with a bad tremor, who sometimes drooled, and who needed lots of physical assistance. I say that with great respect; tremors, drooling, and a need for physical assistance do not diminish human dignity. Even in his last days, this sick, elderly man transfixed a world that often does not seem to care much about such things with his faith, spiritual vigor, and humanity.

Second, John Paul II's death underscored the reality that most deaths are not unusual or controversial. Those who have had chronic diseases for a long time and people who are old die. The Holy Father's case was common: he had suffered from Parkinson's disease, gradually deteriorated, and then met with a series of other illnesses, including the flu and a severe urinary tract infection, that led to death.

Why, then, are so many surprised that they and their loved ones are not immortal? Why is it that some individuals who proclaim they are good Catholics use this to justify their insistence that an elderly family member be put through aggressive efforts in an ICU?

"Far too often in my practice of medicine I meet older patients and their children who seem amazed that death comes for everyone, shocked at the idea that there comes a time when further efforts at resistance are not sensible. If the Holy Father can die in his own bed, then why do people think it against Church teaching to allow an elderly relative who has been declining and now is clearly dying the opportunity to die peacefully?"

Third, the Holy Father's death focused on his spiritual journey, a worldwide recognition of his contributions to all humanity, and a celebration of the gift of his life. Why don't individuals take their own spiritual journey seriously and make preparations, including creation of an advance directive to protect those spiritual values? Why don't people love their family members enough to make sure that their end-of-life care allows a dying process that is part of a journey back to God?

Too frequently a person's dying focuses on medical care, doctors, and technology rather than in thinking about Christ and the sacraments.

That last line makes me sounds old-fashioned, but I have been deeply impressed by how the dying process is a time when one can truly understand the meaning of the early Church writers who described Christ as the divine physician, who talked about the sacraments as medication.

It makes me sad when patients and families put their faith in a ventilator rather than God. Technology can save ill individuals, but it can also allow great suffering and be a way of evading a trust that God's love and care is even bigger than death.

John Paul II had people saying the rosary, masses at his bedside, and the comfort of the sacraments. That's the kind of intensive care that we should choose at the end of a long life or after a long battle with a life-threatening illness or accident.

Focusing on controversy misses reality. Looking to John Paul II's death allows us to learn how to prepare for the end of life. It can also show us how we should care for the dying by focusing on the common ways we die rather than looking to extremely difficult, sad, and controversial cases, such as that of Terri Schiavo, who died after her feeding tube was withdrawn by court order.

The key point in the contrast between these two cases is that John Paul II's death is the way most of us will die, at an old age after a chronic illness, while the situation of Terri Schiavo and other persons afflicted with serious brain injuries is extraordinarily rare and a profound tragedy.

"As Christians, in our dying, we have the choice as Jesus did to give over our human will and to unite it with the Father. That's the way to fulfill the point of our existence."

Keeping sight of the common ways we die while remaining alert to the tragic and extraordinary is a difficult balance. Some criticized while others praised John Paul II for a pronouncement made in March 2004 that it is morally necessary to continue medically assisted feeding and hydration in persons in a persistent vegetative state.

I respect the obligation of the Holy Father to speak out on issues that touch on the margins of life, especially in an age when many think that deliberately taking the life of the sick and dying is a progressive and compassionate step. I can understand the differing reactions to the Holy Father's teaching about feeding tubes in persistent vegetative state.

What is disturbing, however, is that many of the faithful have been confused and distracted by strident pronouncements, exaggerated claims, and overheated rhetoric. It is extremely upsetting how little attention John Paul II received from the secular as well as the religious media when he subsequently reaffirmed Church teaching on decisions about instituting, withholding, and withdrawing medical treatments-other than the specific case of maintaining medically assisted feeding and hydration for patients in a persistent vegetative state-when he spoke to participants at the Pontifical Council Health Pastoral Care conference in November 2004:

True compassion ... encourages every reasonable effort for the patient's recovery. At the same time, it helps draw the line when it is clear that no further treatment will serve this purpose. The refusal of aggressive treatment is neither a rejection of the patient nor of his or her life. Indeed, the object of the decision on whether to begin or to continue a treatment has nothing to do with the value of the patient's life, but rather with whether such medical intervention is beneficial for the patient. The possible decision either not to start or to halt a treatment will be deemed ethically correct if the treatment is ineffective or obviously disproportionate to the aims of sustaining life or recovering health. Consequently, the decision to forego aggressive treatment is an expression of the respect that is due to the patient at every moment.

The way John Paul II died taught us the real meaning of this teaching. I just hope people were paying attention.

Death remains difficult, fraught with fear, sadness, and doubt, but our faith gives us the resources to face the end of life. As a Catholic, I would rather face my dying with prayer and the sacraments than with attempts to assert control over my destiny. Yes, I want a good doctor and a caring nurse, and if I need a little bit, or more, of morphine to relieve my pain, that's fine.

Even with pain control, death still has a sting, and part of the stinger is the doubt that many have, either consciously or unconsciously, that God can love us even at the limits of our earthly life. Jesus faced that doubt and chose for God. As Christians, in our dying, we have the choice as Jesus did to give over our human will and to unite it with the Father. That's the way to fulfill the point of our existence.

That's what I try to preach and certainly need to work on personally as a Jesuit. I also hope I live it when I am dying. And I hope that my efforts will help further the true compassion for the dying, combining prudent medical care with a recognition that death comes for all, which John Paul II taught and exemplified.

Fr. Myles Sheehan, SJ, is Senior Associate Dean of the Education Program and Associate Professor of Medicine at Loyola University Chicago's Stritch School of Medicine.